Prognostic value of sarcopenic visceral obesity in hepatocellular carcinoma treated with TACE

Abstract

Although Transartial chemoembolization (TACE) is one of the recommended treatments for hepatocellular carcinoma (HCC), there is always a dispute on the selection of the best beneficiary for treatment. We studied the prognostic value of nutritional markers, obesity, visceral obesity and sarcopenia on survival outcomes under single and different combinations. In a retrospective cohort of 235 patients with HCC at different stages, more accurate comprehensive prognostic factors were obtained by combining and comparing the multifactor hazard ratios (HR) of various parameters, including skeletal muscle index (SMI) and visceral fat index (VFI) obtained by computer tomography, laboratory index albumin-to-globulin (A/G) ratio, anthropometric body mass index (BMI) and other parameters. The study cohort was dominated by men (73.6%), with a median age of 54 years. According to the survival outcome of HCC patients, we obtained the ideal sex cutoff value of VFI: ≥40.54 cm2/m2 for males (the receiver operating characteristic curve [ROC] = 0.764, P < .001) and ≥ 43.19 cm2/m2 for females (ROC = 0.718, P < .05). According to the results of multifactor analysis, sarcopenic visceral obesity (HR = 8.35, 95% confidence intervals [CI] = [4.96, 14.05], P < .001) is more effective than any single or combined prognosis assessment, including sarcopenic dystrophy (HR = 2.70, 95% CI = [1.85, 3.95], P < .001), sarcopenic obesity (HR = 5.23, 95% CI = [3.41, 8.02], P < .001), sarcopenia (HR = 5.74, 95% CI = [3.61, 9.11], P < .001) and visceral obesity (HR = 3.44, 95% CI = [2.24, 5.27], P < .001). Sarcopenic visceral obesity, defined by SMI and VFI, is a more objective and accurate prognostic indicator of HCC.