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. 2023 Sep;12(17):17569-17580.
doi: 10.1002/cam4.6374. Epub 2023 Jul 26.

Body composition is associated with disease aetiology and prognosis in patients undergoing resection of intrahepatic cholangiocarcinoma

Isabella Lurje  1 , Deniz Uluk  2 , Sandra Pavicevic  2 , Minh Duc Phan  1 , Dennis Eurich  2 , Uli Fehrenbach  3 , Dominik Geisel  3 , Timo Alexander Auer  3 , Uwe Pelzer  4 , Dominik Paul Modest  4 , Nathanael Raschzok  2 , Igor Maximilian Sauer  2 , Wenzel Schöning  2 , Frank Tacke  1 , Johann Pratschke  2 , Georg Lurje  2
Affiliations

Body composition is associated with disease aetiology and prognosis in patients undergoing resection of intrahepatic cholangiocarcinoma

Isabella Lurje et al. Cancer Med. 2023 Sep.

Abstract

Background: Body composition alterations are frequent in patients with cancer or chronic liver disease, but their prognostic value remains unclear in many cancer entities.

Objective: We investigated the impact of disease aetiology and body composition after surgery for intrahepatic cholangiocarcinoma (iCCA), a rare and understudied cancer entity in European and North American cohorts.

Methods: Computer tomography-based assessment of body composition at the level of the third lumbar vertebra was performed in 173 patients undergoing curative-intent liver resection for iCCA at the Department of Surgery, Charité - Universitätsmedizin Berlin. Muscle mass and -composition as well as subcutaneous and visceral adipose tissue quantity were determined semi-automatically. (Secondary) sarcopenia, sarcopenic obesity, myosteatosis, visceral and subcutaneous obesity were correlated to clinicopathological data.

Results: Sarcopenia was associated with post-operative morbidity (intraoperative transfusions [p = 0.027], Clavien-Dindo ≥ IIIb complications [p = 0.030], post-operative comprehensive complication index, CCI [p < 0.001]). Inferior overall survival was noted in patients with myosteatosis (33 vs. 23 months, p = 0.020). Fifty-eight patients (34%) had metabolic (dysfunction)-associated fatty liver disease (MAFLD) and had a significantly higher incidence of sarcopenic (p = 0.006), visceral (p < 0.001) and subcutaneous obesity (p < 0.001). Patients with MAFLD had longer time-to-recurrence (median: 38 vs. 12 months, p = 0.025, log-rank test). Multivariable cox regression analysis confirmed only clinical, and not body, composition parameters (age > 65, fresh frozen plasma transfusions) as independently prognostic for overall survival.

Conclusion: This study evidenced a high prevalence of MAFLD in iCCA, suggesting its potential contribution to disease aetiology. Alterations of muscle mass and adipose tissue were more frequent in patients with MAFLD.

Keywords: MAFLD; NAFLD; liver cancer; visceral obesity.

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Conflict of interest statement

Georg Lurje reports receiving travel support and speakers' fees from Astellas Pharma, XVIVO, Bridge to Life, Aferetica S.R.L outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Typical physiological body composition versus typical metabolic dysfunction‐associated fatty liver disease (MAFLD)‐associated body composition. Compared to physiological body composition (A), the typical MAFLD‐associated changes of body composition depicted here (B) are an increased subcutaneous fat index (subcutaneous fat in light green), increased visceral fat area (visceral fat area, dark green/petrol), normal spinal muscle index (skeletal muscle index, red, no sarcopenia) and lower Hounsfield units‐values (grey intramuscular areas), indicative of intramuscular fat accumulation. (C) Spearman r correlation matrix of MAFLD and body composition parameters (n = 173 patients included for all columns except MAFLD [n = 147]) (D) Distribution of body composition pathologies between non‐MAFLD and MALFD patients with intrahepatic cholangiocarcinoma; chi‐square test with only significant values shown.
FIGURE 2
FIGURE 2
Time to recurrence (A) and overall survival (B) for patients with and without metabolic dysfunction‐associated fatty liver disease.
See this image and copyright information in PMC

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