Muscle and fat matter: Automated CT-based body composition analysis predicts survival in Hepatocellular carcinoma...

This study aimed to assess the prognostic significance of pretreatment CT-based body composition markers in patients with Hepatocellular carcinoma (HCC) treated with radioembolization.

Automated analysis of baseline CT scans was performed to retrospectively evaluate body composition (BCA) parameters in 198 patients from a prospective registry database, including skeletal muscle (SM) and bone (B) volumes. BCA parameters and ratios were dichotomized using a maximally selected log-rank approach. Kaplan-Meier and uni- (UVA) and multivariate (MVA) Cox-proportional-hazard ratio (HR) survival analyses were performed.

The median survival time was 18.5 months. In UVA, lower BCLC stage, ≦ 70 years of age, normal serum albumin, non-elevated C-reactive protein, normal aspartate aminotransferase (ASAT), normal alkaline phosphatase, normal gamma-glutamyl transaminase (GGT), absence of portal vein thrombosis and various BCA parameters were statistically significant with the skeletal muscle to bone ratio (SM/B) demonstrating the strongest survival discrimination with a median survival of 23.6 months for high and 12.0 months for low SM/B (HR: 0.65, 95 %CI: 0.46-0.9; p = 0.0001). In MVA, SM/B, BCLC stage, ASAT, and GGT remained independently significant. Patients with higher SM/B ratios demonstrated a significantly higher disease control rate during the initial imaging follow-up after three months (74.4 % vs. 54.0 %, p = 0.017).

These findings suggest that fully automated, CT-based measurement of BCA parameters - particularly the SM/B ratio - can serve as an independent prognostic factor for survival and disease control in patients with Hepatocellular carcinoma (HCC) undergoing radioembolization. This could potentially facilitate the identification of patients who would benefit most from this treatment.