Vücut Kompozisyonu Değişikliklerinin (Sarkopeni, Miyosteatoz, Ciltaltı ve Viseral Yağ Dokusu Artışı) İntraarteryal Tedavi Uygulanan Primer ve Sekonder Karaciğer Maligniteli Hastalardaki Prognostik Rolünün Araştırılması

Abstract

Ozbay Y, Investigation of the prognostic value of body composition changes (sarcopenia, myosteatosis, subcutaneous and visceral fat tissue increase) in patients with primary and secondary liver malignancies receiving intra-arterial treatment. Hacettepe University, Department of Radiology, Thesis In Radiology, Ankara, 2023. Purpose: We aimed to evaluate the effect of pre-procedure body composition values (sarcopenia, myosteatosis, subcutaneous and visceral fat tissue index increase) on treatment response and survival, as well as the body composition changes observed in control imaging on survival in hepatocellular cancer (HCC) and metastatic colorectal cancer (mCRC) patients who received intraarterial treatment. Materials and Methods: A total of 160 HCC (mean age: 63.45±11.79, M/F: 123/37) and 146 colorectal cancer patients with liver metastases (mean age: 59.98±11.94, M/F: 90/56) which we were treated intra-arterial therapy between January 1, 2012 and December 31, 2022 were included in our study. We determined the patient body composition values (skeletal muscle area, skeletal muscle density, subcutaneous fat tissue area and visceral fat tissue area) by measuring at the L3 vertebra level on the patients' CT scans obtained within 30 days before the procedure. Thresholds defined in the literature were used for the definition of sarcopenia and myosteatosis; whereas the median values of our own patient population were used for subcutaneous and visceral adiposity definitions. The relationship between body composition values and treatment response was analysed, and the factors affecting treatment response were investigated using the univariate binomial logistic regression analyses. Then, the body composition values-survival relationship and the treatment response-survival relationship were evaluated by the Kaplan-Meier survival analysis. Changes in body composition values were measured according to mRECIST guideline for HCC and RECIST 1.1 guideline for mCRC in follow-up imaging of the patients, and the relationship of negative or positive changes with survival was evaluated by Kaplan-Meier survival analysis. After that, factors affecting progression-free and overall survival were investigated using univariate and multivariate Cox-regression analyses. In addition, the factors affecting survival were re investigated by eliminating differences in baseline patient characteristics and reducing selective bias with the "propensity score matching" (PSM) analyses. Results: In the hepatocellular cancer patient group, the local disease control rate was 77.7% and the objective response rate was 55.4%. Factors affecting treatment response (objective response) were revealed as male gender (odds ratio: 0.30, 95% confidence interval: 0.11-0.81, p=0.017), ECOG score (odds ratio: 0.26, 95% confidence interval: 0.08-0.89, p=0.032), AFP level (odds ratio: 0.36, 95% confidence interval: 0.16-0.81, p=0.014) and ALBI score (odds ratio: 7.23, 95% confidence interval: 0.76-68.61, p=0.085) as a result of multivariate logistic regression analysis, The survival times of both sarcopenic and myosteatotic patient groups are statistically significantly shorter than the opposite groups. The survival times of patients with local disease control or objective response groups are statistically significantly longer than the opposite groups. In control imaging, both the progression-free and overall survival times of those with a decrease in skeletal muscle index are shorter, while those with a decrease in skeletal muscle density have shorter overall survival times. As a result of multivariate cox-regression analysis, the factors affecting overall survival were the presence of previous treatment (hazard ratio: 0.51, 95% confidence interval: 0.31-0.84, p = 0.009), Child stage (p = 0.004), albumin level (hazard ratio = 1.56, 95% confidence interval=1.06-2.31, p=0.024), AFP level (hazard ratio:1.83, 95% confidence interval: 1.22-2.75, p=0.003), sarcopenia (hazard ratio=1.59, 95% confidence interval=1.05- 2.41, p=0.029), myosteatosis (hazard ratio=1.96, 95% confidence interval=1.32-2.92, p=0.001) and decreased skeletal muscle index in control (hazard ratio=2.13, 95% confidence interval=1.41-3.22, p< 0.001). As a result of "propensity score matching", among the body composition values were sarcopenia (hazard ratio: 2.06, 95% confidence interval: 1.24-3.42, p=0.005) and decrease in skeletal muscle index in control (hazard ratio: 2.27, 95% confidence interval: 1.35-3.81, p=0.002) are the factors determining overall survival.In the mCRC patient group, the local disease control rate was 53.1% and the objective response rate was 23.4%. The factors affecting treatment response (objective response) were the presence of prior treatment (odds ratio: 4.21, 95% confidence interval: 1.36-13.07, p=0.013) and AST increase (odds ratio: 0.22, 95% confidence interval: 0.04-1.07, p=0.061). The survival times of both sarcopenic and myosteatotic patient gropus are statistically significantly shorter than the opposite groups. The survival times of patients with local disease control or objective response groups are statistically significantly longer than the opposite groups. While progression-free and overall survival times are statistically significantly lower in those with a decrease in skeletal muscle index in control imaging (p=0.028 and p=0.016, respectively), the relationship between skeletal muscle density changes and survival is not statistically significant (p=0.608 and p=0.125,respectively). Factors affecting overall survival were ECOG score (hazard ratio = 2.08, 95% confidence interval = 1.44-2.99, p<0.001), LFT elevation (hazard ratio = 1.84, 95% confidence interval = 1.19-2.84, p=0.006), sarcopenia (hazard ratio=2.96, 95% confidence interval=1.68-5.21, p<0.001), decrease in skeletal muscle index in control (hazard ratio=2.03, 95% confidence interval=1.16-3.55, p=0.013) and myosteatosis (hazard ratio = 2.17, 95% confidence interval = 1.31-3.58, p = 0.002). As a result of "propensity score matching", among the body composition values were sarcopenia (hazard ratio: 1.91, 95% confidence interval: 1.20-3.05, p=0.006) and myosteatosis (hazard ratio: 1.97, 95% confidence interval: 1.00-3.87, p=0.049) are the factors determining overall survival. Conclusion: In both our HCC and mCRC patient groups, baseline sarcopenia and myosteatosis are one of the factors affecting the progression-free and overall survival of patients, and the presence of these factors negatively affects the prognosis. In addition, the decrease in skeletal muscle index in control examinations negatively affects the prognosis in both patient groups.