Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma
Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma
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DOI：
10.1016/j.jhep.2015.02.031
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发表时间：
2015-07-01
影响因子：
25.7
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Fujiwara, Naoto;Nakagawa, Hayato;Koike, Kazuhiko
背景与目的：体重指数（BMI）定义的肥胖显著增加了肝细胞癌（HCC）的风险。相比之下，不仅肥胖，而且体重不足与HCC患者的预后不良相关。身体成分的差异而不是BMI被认为是预后的真正决定因素。然而，这一假设尚未得到最终证明。方法：我们通过计算机断层扫描测量了1257例不同分期HCC患者的骨骼肌指数（SMI）、平均肌肉衰减（MA）、内脏脂肪组织指数、皮下脂肪组织指数和内脏与皮下脂肪组织面积比（VSR），综合分析了身体成分对肥胖的影响。在五种身体成分中，低SMI（称为肌肉减少症），低MA（称为肌内脂肪[IMF]沉积）和高VSR（称为内脏肥胖）与死亡率显著相关，与癌症分期或Child-Pugh分级无关。多变量分析显示，（风险比[HR]，1.52; 95%置信区间[CI]，1.18-1.96; p = 0.001），IMF沉积（HR，1.34; 95% CI，1.05-1.71; p = 0.020）和内脏肥胖（HR，1.35; 95% CI，1.09-1.66; p = 0.005）是生存率的重要预测因素，但BMI不是。预后不良的身体成分的患病率显着高于体重不足和肥胖的患者比正常体重patients.Conclusions：肌减少症，IMF沉积，内脏脂肪独立预测肝癌患者的死亡率。身体成分而不是BMI是HCC患者预后的主要决定因素。(C)2015年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
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. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.