Subcutaneous adiposity is an independent predictor of mortality in cancer patients

Abstract

Background: Prognostic significance of adiposity, at the time of cancer diagnosis, on survival is not clear. Body mass index (kg m^-2) does not provide an appropriate assessment of body composition; therefore, the concept of the 'obesity paradox' needs to be investigated based on the prognostic significance of fat and muscle. Independent prognostic significance of adipose tissue in predicting mortality, importance of visceral and subcutaneous adiposity in the presence and absence of sarcopenia on survival, was investigated.

Methods: Adiposity markers including total adipose index (TATI), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) were estimated for 1473 gastrointestinal and respiratory cancer patients and 273 metastatic renal cell carcinoma patients using computed tomography. Univariate and multivariate analysis to determine mortality hazard ratios (HR) were conducted using cox proportional hazard models.

Results: Low SATI (SATI <50.0 cm² m^-2 in males and <42.0 cm² m^-2 in females) independently associated with increased mortality (HR: 1.26; 95% CI: 1.11-1.43; P<0.001) and shorter survival (13.1 months; 95% CI, 11.4-14.7) compared to patients with high SATI (19.3 months; 95% CI, 17.6-21.0; P<0.001). In the presence of sarcopenia, the longest survival was observed in patients with high subcutaneous adiposity.

Conclusions: Subcutaneous adipose tissues appear to associate with reduction in mortality risk demonstrating the prognostic importance of fat distribution. The effect of sarcopenia on survival was more pronounced in patients with low subcutaneous adiposity.

Figure 1

Kaplan–meier survival curves in patients with high vs low subcutaneous adiposity. Kaplan–Meier curves were plotted to estimate survival over time and the log-rank test were used to compare the difference between survival curves. Longer median survival was observed in patients with high subcutaneous adiposity compared to the patients with low subcutaneous adiposity (P<0.001).