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Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma.
J Hepatol 2015; 63(1):131-40JH

Abstract

BACKGROUND & AIMS

Obesity defined by body mass index (BMI) significantly increases the risk of hepatocellular carcinoma (HCC). In contrast, not only obesity but also underweight is associated with poor prognosis in patients with HCC. Differences in body composition rather than BMI were suggested to be true determinants of prognosis. However, this hypothesis has not been demonstrated conclusively.

METHODS

We measured skeletal muscle index (SMI), mean muscle attenuation (MA), visceral adipose tissue index, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratios (VSR) via computed tomography in a large-scale retrospective cohort of 1257 patients with different stages of HCC, and comprehensively analyzed the impact of body composition on the prognoses.

RESULTS

Among five body composition components, low SMI (called sarcopenia), low MA (called intramuscular fat [IMF] deposition), and high VSR (called visceral adiposity) were significantly associated with mortality, independently of cancer stage or Child-Pugh class. A multivariate analysis revealed that sarcopenia (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.18-1.96; p=0.001), IMF deposition (HR, 1.34; 95% CI, 1.05-1.71; p=0.020), and visceral adiposity (HR, 1.35; 95% CI, 1.09-1.66; p=0.005) but not BMI were significant predictors of survival. The prevalence of poor prognostic body composition components was significantly higher in underweight and obese patients than in normal weight patients.

CONCLUSIONS

Sarcopenia, IMF deposition, and visceral adiposity independently predict mortality in patients with HCC. Body composition rather than BMI is a major determinant of prognosis in patients with HCC.

Authors+Show Affiliations

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan. Electronic address: tateishi-tky@umin.ac.jp.Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Japan.Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan.Department of Gastroenterology, Juntendo University, Japan.Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25724366

Citation

Fujiwara, Naoto, et al. "Sarcopenia, Intramuscular Fat Deposition, and Visceral Adiposity Independently Predict the Outcomes of Hepatocellular Carcinoma." Journal of Hepatology, vol. 63, no. 1, 2015, pp. 131-40.
Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131-40.
Fujiwara, N., Nakagawa, H., Kudo, Y., Tateishi, R., Taguri, M., Watadani, T., ... Koike, K. (2015). Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. Journal of Hepatology, 63(1), pp. 131-40. doi:10.1016/j.jhep.2015.02.031.
Fujiwara N, et al. Sarcopenia, Intramuscular Fat Deposition, and Visceral Adiposity Independently Predict the Outcomes of Hepatocellular Carcinoma. J Hepatol. 2015;63(1):131-40. PubMed PMID: 25724366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. AU - Fujiwara,Naoto, AU - Nakagawa,Hayato, AU - Kudo,Yotaro, AU - Tateishi,Ryosuke, AU - Taguri,Masataka, AU - Watadani,Takeyuki, AU - Nakagomi,Ryo, AU - Kondo,Mayuko, AU - Nakatsuka,Takuma, AU - Minami,Tatsuya, AU - Sato,Masaya, AU - Uchino,Koji, AU - Enooku,Kenichiro, AU - Kondo,Yuji, AU - Asaoka,Yoshinari, AU - Tanaka,Yasuo, AU - Ohtomo,Kuni, AU - Shiina,Shuichiro, AU - Koike,Kazuhiko, Y1 - 2015/02/24/ PY - 2014/09/02/received PY - 2015/02/02/revised PY - 2015/02/18/accepted PY - 2015/3/1/entrez PY - 2015/3/1/pubmed PY - 2016/4/1/medline KW - Body composition KW - Body mass index KW - Hepatocellular carcinoma KW - Prognosis SP - 131 EP - 40 JF - Journal of hepatology JO - J. Hepatol. VL - 63 IS - 1 N2 - BACKGROUND & AIMS: Obesity defined by body mass index (BMI) significantly increases the risk of hepatocellular carcinoma (HCC). In contrast, not only obesity but also underweight is associated with poor prognosis in patients with HCC. Differences in body composition rather than BMI were suggested to be true determinants of prognosis. However, this hypothesis has not been demonstrated conclusively. METHODS: We measured skeletal muscle index (SMI), mean muscle attenuation (MA), visceral adipose tissue index, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratios (VSR) via computed tomography in a large-scale retrospective cohort of 1257 patients with different stages of HCC, and comprehensively analyzed the impact of body composition on the prognoses. RESULTS: Among five body composition components, low SMI (called sarcopenia), low MA (called intramuscular fat [IMF] deposition), and high VSR (called visceral adiposity) were significantly associated with mortality, independently of cancer stage or Child-Pugh class. A multivariate analysis revealed that sarcopenia (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.18-1.96; p=0.001), IMF deposition (HR, 1.34; 95% CI, 1.05-1.71; p=0.020), and visceral adiposity (HR, 1.35; 95% CI, 1.09-1.66; p=0.005) but not BMI were significant predictors of survival. The prevalence of poor prognostic body composition components was significantly higher in underweight and obese patients than in normal weight patients. CONCLUSIONS: Sarcopenia, IMF deposition, and visceral adiposity independently predict mortality in patients with HCC. Body composition rather than BMI is a major determinant of prognosis in patients with HCC. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/25724366/Sarcopenia_intramuscular_fat_deposition_and_visceral_adiposity_independently_predict_the_outcomes_of_hepatocellular_carcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(15)00141-5 DB - PRIME DP - Unbound Medicine ER -