Prognostic value of CT-based skeletal muscle and adipose tissue mass and quality parameters in patients with liver metastases and intrahepatic cholangiocarcinoma undergoing Yttrium-90 radioembolization

Abstract

Objectives: To investigate baseline patient characteristics associated with the risk of computed tomography (CT)-based sarcopenia and assess whether sarcopenia and other morphometric parameters influence survival outcomes in patients with liver metastases and cholangiocarcinoma after Yttrium-90 radioembolization.

Materials and methods: We retrospectively analyzed 120 cancer patients (mean age, 62 ± 13.3 years, 61 men) who underwent preprocedural CT. Skeletal muscle index (SMI) was measured at the L3 vertebral level to identify sarcopenia. The Cox proportional hazard model was performed to assess the prognostic value of the variables, and Kaplan-Meier analysis with log-rank text was used for overall survival (OS) assessment.

Results: Sarcopenia was diagnosed in 70 patients (58.3%). The multivariate regression analysis demonstrated that male sex, body mass index (BMI), visceral fat radiation attenuation (VFRA), skeletal muscle radiation attenuation (SMRA), and subcutaneous fat radiation attenuation (SFRA) were associated with the incidence of sarcopenia with the odds ratio of 8.81 (95% CI, 2.09-37.1, p = 0.003), 0.64 (95% CI, 0.48-0.85, p = 0.002), 1.23 (95% CI, 1.06-1.42, p = 0.006), 0.79 (95% CI, 0.69-0.91, p = 0.001) and 0.84 (95% CI, 0.76-0.93, p = 0.001), respectively. Age, skeletal muscle index, and tumor subtypes were independent prognostic factors for OS with the hazard ratio of 1.03 (95% CI, 1.01-1.05, p = 0.01), 0.92 (95% CI, 0.86-0.99, p = 0.021) and 2.09 (95% CI, 1.31-3.33 p = 0.002), respectively. In patients with intrahepatic cholangiocarcinoma, median OS was significantly longer in the non-sarcopenic group than in the sarcopenic patient (25.9 versus 6.5 months, p = 0.029).

Conclusion: Male sex, BMI, VFRA, SMRA, and SFRA were associated with the incidence of sarcopenia. SMI value could be used as a biomarker for OS in patients treated with Yttrium-90 radioembolization.

Key points: Question The prognostic significance of CT-based sarcopenia and other morphometric parameters in patients with liver metastases and cholangiocarcinoma undergoing Yttrium-90 radioembolization remains unclear. Findings A high skeletal muscle index has been identified as an independent protective factor for overall survival in cancer patients treated with Yttrium-90 radioembolization. Clinical relevance The negative impact of CT-based sarcopenia has been confirmed in the context of Yttrium-90 radioembolization. Clinicians should strive to prevent the progression of sarcopenia or maintain skeletal muscle index in perioperative management.

Keywords: Cholangiocarcinoma; Muscle; Prognosis; Sarcopenia; Yttrium-90.

Fig. 1

Computed tomography image (L3) shows the different tissue segmentations after thresholding in a patient with liver metastasis before ⁹⁰Y-radioembolization. The color-coded areas represent the skeletal muscle area (A), intermuscular adipose tissue area (B), visceral fat area (C), and subcutaneous fat area (D)

Fig. 2

Correlation analysis of SMI with BMI, VATI, and VFRA. SMI, skeletal muscle index; BMI, body mass index; VATI, visceral adipose tissue index; VFRA, visceral fat radiation attenuation

Fig. 3

Forest plot showing factors associated with the risk of sarcopenia. BMI, body mass index; SMRA, skeletal muscle radiation attenuation; SFRA, subcutaneous fat radiation attenuation; SATI, subcutaneous adipose tissue index; VATI, visceral adipose tissue index; VFRA, visceral fat radiation attenuation; IMATI, intramuscular adipose tissue index; BMI, body mass index

Fig. 4

A The incidence of sarcopenia was significantly lower in the obesity group than in the other groups. B Survival analysis with Kaplan–Meier curves showing median OS among normal/underweight, overweight and obesity groups. **p < 0.01

Fig. 5

Survival analysis. A Overall survival in the whole cohort. B Overall survival in sarcopenic vs. non-sarcopenic patients. C Overall survival of patients with various primary malignant tumors significantly differed among groups

Fig. 6

Forest plot of factors associated with overall survival. BMI, body mass index; SMRA, skeletal muscle radiation attenuation; SFRA, subcutaneous fat radiation attenuation; SATI, subcutaneous adipose tissue index; VATI, visceral adipose tissue index; VFRA, visceral fat radiation attenuation; IMATI, intermuscular adipose tissue index; BMI, body mass index