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A 23-year-old woman with congenital generalized lipodystrophy and fifth finger pain. Lytic lesion (arrowheads) was evident on (a) radiograph and (b) CT in the fifth middle phalange. c CT showed almost complete loss of fat tissue other than the palmar fat pad (arrow). MRI showed complete lack of bone marrow adipose tissue. Coronal (d) T2-weighted and (e) STIR images show almost the same signal. f T1-weighted image shows no adipose high signal intensity. An asterisk denotes the referred lytic lesion. g DIXON-based fat image shows almost complete loss of fat high signal in the bone marrow and soft tissue
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Adipose tissue plays multiple and complex roles not only in mechanical cushioning and energy storage but also as an important secretory organ that regulates energy balance and homeostasis multilaterally. Fat tissue is categorized into subcutaneous fat tissue (SCAT) or visceral fat tissue (VSA) depending on its distribution, with the two having diff...
Contexts in source publication
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... and MRI demonstrate the nearly complete absence of adipose tissue well, whereas adipose tissue may be preserved in the orbits, mouth, tongue, palms and soles, scalp, perineum, and periarticular regions [14] ( Figs. 1 and 2). Lytic lesions may be formed in the long bones or appendicular bones after puberty [15]. ...
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... fossa, spinal canal (spinal epidural lipomatosis), cheeks (moon face), or dorsocervical fat pad (buffalo hump) [39,42]. Buffalo hump in Cushing's syndrome is usually consistent with the general degree of obesity. In the muscle, weakness and proximal muscle wasting are induced by the catabolic effects of excess glucocorticoid on the Fig. 16 Superficial lipoma in a 60-year-old woman on the right shoulder. a T1-weighted image and (b) fat-suppressed T2-weighted show a homogeneous fatty mass (arrows) with a similar signal intensity to that of the adjacent subcutaneous fat but with a thin capsule and thin internal septa skeletal muscle. Osteoporosis is caused by decreased ...
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... involving the subcutaneous compartment resulting in lipoatrophy [44]. They are usually localized but rarely progress to acquired generalized lipoatrophy [12]. Morphea is classically confined to the skin and/or underlying tissues but may extend over muscular fascia, muscle tissue, tendons, joint synovia, and even bone marrow (deep morphea) (Fig. 10). Morphea usually manifests as a single wellcircumscribed lesion on the extremities or upper trunk, near the spine with keloid-like hard and shiny skin changes [45]. MRI shows localized lipoatrophy under the depressed thickened skin with or without varying degree of signal change in underlying fascia and musculature involvement. It is ...
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... [46]. Parry-Romberg syndrome (PRS), also known as progressive hemifacial atrophy, clinically overlaps with LScs and can even affect the brain [47]. CT and MRI may show cerebral hemiatrophy or high signal of white matter on T2-weighted image ipsilateral to the affected facial side not only atrophy of the skin and underlying bone and soft tissue (Fig. 11) ...
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... Post-traumatic lipoatrophy/hypertrophy Posttraumatic subcutaneous lipoatrophy occurs following a fall, blunt injury (Fig. 12), or surgery (Fig. 13), with subsequent fat tissue damage, organized hemorrhage, fat necrosis, and fibrosis [51]. Often, the interval between the injury and initial observation of the deformity is prolonged. It is more prevalent in women and children, usually appearing on the shins, thighs, arms, breasts, and buttocks [52]. The ...
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... Post-traumatic lipoatrophy/hypertrophy Posttraumatic subcutaneous lipoatrophy occurs following a fall, blunt injury (Fig. 12), or surgery (Fig. 13), with subsequent fat tissue damage, organized hemorrhage, fat necrosis, and fibrosis [51]. Often, the interval between the injury and initial observation of the deformity is prolonged. It is more prevalent in women and children, usually appearing on the shins, thighs, arms, breasts, and buttocks [52]. The radiologic appearance of ...
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... reported as the cause [55]. Repetitive mechanical stress also induces a prominent increase in the volume of subcutaneous adipose tissue. By carrying heavy loads, abnormal local fat accumulation on the shoulder has been reported in festival participants in Japan and Southern Italy, wine porters, brewery workers, and heavy handbag carriers [56]. Fig. 19 Lipomatosis of the median nerve in an 11-year-old girl without symptoms. a Axial T2-and (b) coronal T1-weighted images reveal softtissue hypertrophy with predominance of fat in the radial side of the middle finger along with the neurovascular structure (arrows) Fig. 20 Atypical lipomatous tumor in a 62-year-old male with a painless, ...
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... the right back. a Coronal CT image shows a fat-containing inhomogeneous density mass (arrow). b On post-contrast fat-saturated T1-weighted image, the non-fatty lesion shows moderate enhancement (arrowheads). Surgically diagnosed as ALT with abundant fat necrosis On CT and MRI, an increase in the volume of noncapsulated adipose tissue is evident (Fig. ...
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... lipoatrophy is a type of localized lipoatrophy characterized by band-like horizontal depressions measuring 2 to 4 cm in width, located on the anterolateral aspect of the thighs (Fig. 15). The most widely accepted cause is repetitive microtrauma against such as the edge of furniture or tight-fitting clothes [57]. Semicircular lipoatrophy is frequently reported among office working women aged 20 to 40 years. The lesion is typically observed at 72-73 cm above the ground, which is the standard height of office furniture ...
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... accounts for approximately 50% of all soft tissue tumors and the most common subcutaneous neoplasm consists mainly of mature adipose tissue [64]. Lipoma usually demonstrates an encapsulated high signal mass on T2-and T1-weighted images that contain thin septa less than 2 mm, with suppression on fat saturated images (Fig. 16), but some show a non-capsulated pattern. Lipoma commonly manifests as a solitary mass but can also manifest as multiple masses in 5-15% of cases [64]. Those atypical lipomas can resemble non-neoplastic abnormal fat distribution conditions. Lipomas are usually asymptomatic, though local pain, tenderness, or nerve compression is ...
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... multiple, small subcutaneous mass with tenderness located commonly in the forearm, upper arm, or trunk [66]. The MR imaging features of these lesions are the presence of fat nodules with or without low signal on T1-or T2-weighted images with or without high signal on fat saturated T2-weighted images representing the prominent vasculature [67] (Fig. 17). Lipogranulomas found with post-traumatic lipoatrophy/lipohypertrophy would be the differential diagnosis, though the presence of pain, absence of traumatic history, and normal distribution of surrounding subcutaneous fat demonstrate the different nature of those conditions. Spindle cell/pleomorphic lipoma is a benign, ...
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... with varying proportions of spindle cells with rope-like collagen bundles [69]. Fat is reported to be detectable in 89% of these lesions, ranging from 25% to 75% of the tumor volume on MRI [70]. Non-adipose components are similar to those of skeletal muscle on T1-weighted imaging and hyperintense on fat-saturated fluid-sensitive sequences (Fig. 18) Intense enhancement of the non-adipose component further supports this diagnosis. The mass is generally firmer than lipomas or most conditions with non-neoplastic localized abnormal fat distribution. When it occurs in atypical locations, it becomes challenging to differentiate from liposarcomas or even other non-adipose soft tissue ...
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... fibrolipoma [64]. This condition most commonly occurs in patients before 30 years of age, involving the median nerve of the wrist and hand. Accompanying varying degrees of mesenchymal overgrowth including adipose tissue with frequent sensory symptoms such as paresthesia or numbness, with or without macrodactyly, is the typical presentation [71] (Fig. 19). The location and adipose tissue distribution interspersing nerve bundles are imaging findings distinctive from those of already discussed non-neoplastic abnormal fat distribution conditions. Well-differentiated liposarcoma/atypical lipomatous tumor (ALT) is the most common liposarcoma, classified as an intermediate (locally ...
Citations
... Conversely, subcutaneous fat, found just beneath the skin, exhibits more protective associations. [49] This is regarded as a crucial factor for bone health because adipose tissue, acting as a central hub for various hormones and inflammatory elements, regulates numerous bodily functions. This hormonal connection further complicates the association between adipose tissue and bone. ...
Vitamin D (ViD), plays an important role in calcium absorption and bone mineralization, is associated with bone mineral density. Severe deficiency in ViD has long been linked to conditions such as rickets in children and osteomalacia in adults, revealing its substantial role in skeletal health. Additionally, investigations show an existing interconnection between ViD and insulin resistance (Ins-R), especially in patients with type 2 diabetes mellitus (T2DM). Obesity, in conjunction with Ins-R, may augment the risk of osteoporosis and deterioration of skeletal health. This review aims to examine recent studies on the interplay between ViD, Ins-R, obesity, and their impact on skeletal health, to offer insights into potential therapeutic strategies. Cochrane Library, Google Scholar, and Pubmed were searched to investigate relevant studies until December 2023. Current research demonstrates ViD’s impact on pancreatic β-cell function, systemic inflammation, and insulin action regulation. Our findings highlight an intricate association between ViD, Ins-R, obesity, and skeletal health, providing a perspective for the prevention and/or treatment of skeletal disorders in patients with obesity, Ins-R, and T2DM.
... In contrast, it has been reported that rapid depletion of SATI during SOR treatment is significantly associated with poor survival in patients with HCC [15]. Since the SAT functions as a metabolic reservoir to store excess energy [36], it may be the primary source of energy when treatment induces a negative energy balance. Further studies are needed to determine the prognostic impact of the reduction in SATI, which may be an indicator of extreme nutritional impairment, on patients with HCC. ...
Simple Summary
Skeletal muscle depletion is one of the established prognostic factors for hepatocellular carcinoma (HCC). This study clearly demonstrated that skeletal muscle mass continued to decrease significantly during lenvatinib (LEN) or sorafenib (SOR) treatment, which has recently played a major role in the treatment of unresectable HCC. Furthermore, the survival analysis using time-varying covariates in this study revealed that it was one of the independent prognostic factors together with tumor makers and liver functional reserve. These results can help improve the management of unresectable HCC because they suggest that it is essential to prevent skeletal muscle depletion, especially in using LEN/SOR to improve survival in HCC patients.
Abstract
This study aimed to assess the effects of lenvatinib (LEN) or sorafenib (SOR) treatment for hepatocellular carcinoma (HCC) on body composition and changes in body composition on survival. This study enrolled 77 HCC patients. Skeletal muscle index (SMI), subcutaneous and visceral adipose tissue indices (SATI and VATI), AFP, PIVKA-II, and ALBI scores were analyzed at the time of LEN/SOR introduction, three months after the introduction, at treatment discontinuation, and the last observational time. The differences between chronological changes in these values were analyzed using a paired t-test. The Cox proportional hazards model was used to analyze prognostic factors using time-varying covariates. The chronological changes in each factor were 45.5–43.6–40.6–39.8 (cm²/m²) for SMI, 41.7–41.6–36.3–33.7 (cm²/m²) for SATI, 41.9–41.1–37.1–34.8 (cm²/m²) for VATI, 2.379–26.42–33.61–36.32 (×10³ ng/mL) for AFP, 9.404–13.39–61.34–25.70 (×10³ mAU/mL) for PIVKA-II, and −2.56–−2.38–−1.99–−1.90 for the ALBI score. The presence of pre-treatment (p = 0.042), AFP (p = 0.002), PIVKA-II (p < 0.001), ALBI score (p < 0.001), and SMI (p = 0.001) were independent prognostic factors. Skeletal muscle mass decreases significantly during LEN/SOR treatment and is an independent prognostic factor for HCC.
... The mechanism may be VAT contains more large adipocytes secreting adipokines involved in hepatocarcinogenesis compared to SAT (23). Previous studies could speculate about the inferred explanation: (1) an increase in VAT can result in a stronger inflammatory response, which is related to the inflammatory response, and the secretion of inflammatory factors directly into the liver, eventually leading to inflammation of the liver and the development of HCC as a result (22,(27)(28)(29); (2) VAT also contributes to the development of insulin resistance, wherein insulin can exert mitogenic effects by activating its receptors in precancerous and cancer cells, which results vascular damage and vascular endothelial growth factor release, and cause oncogenesis, tumor progression and poor prognosis (15,28,30,31). Therefore, as pointed out by previous studies (14,15), pharmacological or nutritional interventions, and exercise enhancement can be used to improve chronic inflammation, reduce insulin resistance, and improve the long-term survival of patients with HCC with high VAT. ...
... The mechanism may be VAT contains more large adipocytes secreting adipokines involved in hepatocarcinogenesis compared to SAT (23). Previous studies could speculate about the inferred explanation: (1) an increase in VAT can result in a stronger inflammatory response, which is related to the inflammatory response, and the secretion of inflammatory factors directly into the liver, eventually leading to inflammation of the liver and the development of HCC as a result (22,(27)(28)(29); (2) VAT also contributes to the development of insulin resistance, wherein insulin can exert mitogenic effects by activating its receptors in precancerous and cancer cells, which results vascular damage and vascular endothelial growth factor release, and cause oncogenesis, tumor progression and poor prognosis (15,28,30,31). Therefore, as pointed out by previous studies (14,15), pharmacological or nutritional interventions, and exercise enhancement can be used to improve chronic inflammation, reduce insulin resistance, and improve the long-term survival of patients with HCC with high VAT. ...
Background
This study aimed to investigate whether visceral adipose tissue index (VATI) is a significant risk factor for the early recurrence (ER) of HBV-related hepatocellular carcinoma (HCC) (≤5 cm) after hepatectomy.
Methods
The recruited cohort patients who were positive for hepatitis B virus, presented with surgically confirmed HCC (≤5 cm) from Army Medical University (internal training cohort: n = 192) and Chongqing Medical University (external validation group: n = 46). We measured VATI, subcutaneous adipose tissue index (SATI) via computed tomography (CT). ER was defined as recurrence within 2 years after hepatectomy. The impact of parameters on outcome after hepatectomy for HCC was analyzed.
Results
Univariate analysis showed that alpha-fetoprotein levels ( p = 0.044), body mass index (BMI) ( p < 0.001), SATI ( p < 0.001), and VATI ( p < 0.001) were significantly different between ER and non-ER groups in internal training cohort. Multivariate analysis identified VATI as an independent risk factor for ER (odds ratio = 1.07, 95% confidence interval: 1.047–1.094, p < 0.001), with a AUC of 0.802, based on the cut-off value of VATI, which was divided into high risk (≥37.45 cm ² /m ² ) and low risk (<37.45 cm ² /m ² ) groups. The prognosis of low risk group was significantly higher than that of high risk group ( p < 0.001). The AUC value of VATI in external validation group was 0.854.
Conclusion
VATI was an independent risk factor for the ER, and higher VATI was closely related to poor outcomes after hepatectomy for HBV-related HCC (≤5 cm).
... The visceral AT surrounds internal organs and includes omental, mesenteric, epididymal, perirenal, retroperitoneal, epicardial 3 . The subcutaneous accounts for almost 80% of human AT, but the visceral is more metabolically active and inflammatory, and its accumulation is a greater predictor of obesity-associated mortality 4 . effects/index.html), obesity decreases healthspan and lifespan and increases premature mortality leading to significant rise in individual, national and global healthcare costs. ...
Obesity represents a serious health problem as it is rapidly increasing worldwide. Obesity is associated with reduced health span and life span, decreased responses to infections and vaccination and increased frequency of inflammatory conditions. In this review, we summarize published data showing that obesity increases the risk of different types of infections, with a special focus on skin infections. Obesity also induces skin changes and conditions (inflammation-based and hypertrophic) which are often associated with fungi or bacteria overgrowth. The association of obesity with the skin microbiome has been established in both mice and humans. Balance of commensal microbes controls skin homeostasis and the host immune response, while changes in normal physiologic skin microbiome composition and pathologic bacteria contribute to skin diseases. We also summarize the major steps in wound healing and how obesity affects each of them. The role that immune cells have in this process is also described. Although the studies summarized in this review clearly demonstrate the deleterious effects of obesity on wound healing, additional studies are needed to better characterize the cellular and molecular mechanisms involved and identify specific targets of intervention.
... al. studied the relationship between hypertrophy of subcutaneous/visceral adipose tissue and FLD. 6 The renal hilum is among the minor fat deposition points of the abdomen. 7 The authors of this paper therefore concluded similarly to the 2020 Yalçın, et. ...
... 12,13 However, since this phrase is widely used in the medical liter- As indicated in earlier studies, diffuse HS is a common condition affecting over 25% of the population. [3][4][5][6][7] This condition has been shown to affect males more often than females. 14 The findings of our study were similar as 85.6% of sample patients with HS were males. ...
Introduction:
It has been established that abnormal fat deposits are associated with fat deposition in other abdominal regions and linked to obesity, diabetes mellitus, hypertension, vascular and metabolic diseases. This study aimed to determine whether there was a relationship between fat deposition of the renal (i.e., kidney) sinus (FRS) and fatty liver disease (FLD) in a sample of adults. The authors hypothesized that FRS could be a diagnostic finding associated with Hepatosteatosis (HS) in a sample of younger patients. This study was the first apparent investigation of this possible phenomenon.
Methods:
A convenience sample of 92 adult patients of which 19 (20.7%) were females and 73 (79.3%) were males, and with a mean age of 30.19 (SD = 6.00) were included. The authors calculated Hounsfield Units (HU) (i.e., relative quantitative measurement of radio density) of patients' livers and spleens on non-contrast computed tomography (CT). Liver and spleen differences < 10 HU were considered steatosis (FLD). The authors stratified sample patients into two analytic subgroups according to the presence of FLD or not and compared them based on their FRS widths.
Results:
In the FLD subgroup (N = 48), the difference of HU values between liver and spleen was -5.19 (SD = 11.32), with a range of -38 - 8 HU, while, in the non-steatosis subgroup (N = 44), the mean difference was 16.36 (SD = 3.90), range of 11 - 26 HU. The average diameter of FRS width was 12.5 mm in those patients with steatosis (FLD subgroup) although 9.3 mm in non-FLD patients. (p = 0.02).
Conclusions:
Based on these results, FRS may be able to be used by radiologists as an ancillary method in the detection of hepatic steatosis in younger adults. The effectiveness of premedical processes (e.g., exercise and diet modification) can also be increased by non-radiologists after detection of lower-grade HS.
... In some cases, however, it may be difficult to determine whether a lipoma is present at a location of symptoms. 19 Imaging characterization of any potential mass requires documentation of additional secondary features such as location, displacement or invasion of adjacent structures, and reaction of surrounding tissues. Correlation for pain or a palpable mass is also clinically important when the imaging features are worrisome. ...
Background Fatty masses are common and may be encountered in the foot and ankle. In some cases, normal subcutaneous fat may be mistaken for a discrete mass.
Aims The aim of this study was to evaluate the common finding of prominent subcutaneous fat at the medial midfoot resembling a lipoma and to determine the prevalence of this pseudolesion by applying a series of potential size cutoff criteria.
Materials and Methods Three musculoskeletal radiologists retrospectively evaluated 91 sequentially performed magnetic resonance imaging examinations of the ankle to measure fat resembling a discrete lipoma at the medial midfoot. Each blinded reader measured the largest area of continuous subcutaneous fat in orthogonal axial, coronal craniocaudal, and coronal transverse dimensions. Patient age, sex, and study indications were also recorded. Statistical analysis was performed with R and SAS 9.4 software
Results A discrete fatty pseudolesion as defined by measuring at least 1 cm in all planes by measurements of at least two of three readers was present in 87% of cases (79 of 91). When a size criterion of 1.5 cm was used, a pseudolesion was documented in 14% of cases (13 of 91). There was a significant correlation between larger pseudolesion size and female sex in the axial plane; however, there was no correlation in the coronal craniocaudal and coronal transverse dimensions.
Conclusions Subcutaneous fat at the medial midfoot often has a mass-like appearance that could be mistaken for a lipoma. It is important to recognize this pseudolesion variant and not to confuse the imaging appearance for a discrete mass.
... Changes in body fat are classified as lipohipertrophy, lipoatrophy and mixed lipodystrophy Lipohipetrophy is characterized as an increase in abdominal, thoracic and cervical fat, lipoatrophy as a decrease of fat in superior and inferior limbs as well as in face, while lipodystrophy is characterized by both manifestations [4][5][6] . Generally, these morphological changes do not affect health 5,6 . ...
... Changes in body fat are classified as lipohipertrophy, lipoatrophy and mixed lipodystrophy Lipohipetrophy is characterized as an increase in abdominal, thoracic and cervical fat, lipoatrophy as a decrease of fat in superior and inferior limbs as well as in face, while lipodystrophy is characterized by both manifestations [4][5][6] . Generally, these morphological changes do not affect health 5,6 . However, the metabolic changes caused by lipodystrophy start serum lipidic and glycidic variations, increasing the risk to chronic diseases with cardiovascular implications 6 . ...
... Generally, these morphological changes do not affect health 5,6 . However, the metabolic changes caused by lipodystrophy start serum lipidic and glycidic variations, increasing the risk to chronic diseases with cardiovascular implications 6 . Lifestyle may influence lipodystrophy, and so, alimentary control and exercises may contribute positively on the manifestation and treatment of this syndrome. ...
The introduction of highly active antiretroviral therapy (HAART) was able to help to control viral condition in patients living with HIV/AIDS, diminishing virus concentration and increasing T CD4 + cells. However, adverse effects follow the treatment, like lipodystrophy syndrome, characterized by morphological changes in body fat distribution and changes serum lipids and glycides levels, increasing the risk for chronical diseases with cardiovascular effects. Thus, complimentary non-drug practices, as strength training, are essential to treat these patients, helping to improve their immunometabolic condition, leading to a better coping with the disease. The aim of this study was to investigate the influence of a 12-week strength training protocol on immunometabolic system of people living with HIV/AIDS. It is a quasi-experimental study, conducted on 20 patients (16 men), all living with HIV/AIDS using HAART. T CD4 + cell numbers, serum triglycerides, cholesterol (total and fractions) and glycemia were measured before and after training. The data underwent to descriptive statistics using a paired T test, with the significance level set at p <0.05.There was a significant increase of 15.4% (p=0.009) on T CD4 + cells and, although not statistically significant, reduction on glycemia, total cholesterol and triglycerides and increase on HDL-cholesterol fraction. So, it is suggested that strength training may be effective on immunometabolic condition of people living with HIV / AIDS, increasing T CD4+ cells and controlling serum levels of lipids and glycides.
... Correlation with CT head and body scans from the same admission confirmed findings of extreme cachexia, with nearcomplete absence of subcutaneous fat in the scalp and body wall ( Fig. 3 ). Residual subcutaneous and visceral fat were found in classic locations of brown adipose tissue (axilla, supra-and infraclavicular fossa, around solid organs) and demonstrated increased density, which is thought to reflect smaller fat cell size with inflammatory/edematous change during lipolysis [5] . This patient declined treatment and died 2 months later with palliative measures. ...
... diminished subcutaneous fat and diffuse T1 hypointense marrow signal in an individual with bulimia nervosa [5] . Kraeft et al reported that individuals with severe anorexia nervosa demonstrate loss of fat signal in both bone marrow and subcutaneous tissues on MRI [6] . ...
Cachexia is a significant contributor to cancer mortality as it is responsible for up to 30% of cancer deaths. Magnetic resonance imaging offers a noninvasive approach to detect features of cachexia. T1-weighted images of cachectic patients have a "pseudo fat-saturated" appearance secondary to disappearance of subcutaneous and fascial fat throughout the body, as well as fat in the bone marrow. Orbital fat remains preserved until late disease. We present 2 cases with these classic imaging findings of cancer cachexia in the subcutaneous tissues of the head, neck, and spine. This imaging phenomenon is often misinterpreted by radiologists and may lead to delayed diagnosis or unnecessary repeat imaging.
... The definite reason SAT alone rapidly decreased just after introducing sorafenib in advance of skeletal muscle and VAT remains unclear. SAT is known to act as metabolic storage that can accumulate superfluous energy [24]. Therefore, we consider that SAT might first be used as an energy source when a negative energy balance is induced by sorafenib. ...
The aim of this study was to assess the annualized changes in body composition, including skeletal muscle, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) before, during, and after sorafenib treatment in patients with hepatocellular carcinoma (HCC). This retrospective study evaluated 61 HCC patients treated with sorafenib. Annualized changes (Δ; cm2/m2/year) in skeletal muscle index (SMI), SAT index (SATI), and VAT index (VATI), which were defined as the cross-sectional areas (cm2) of those areas on computed tomography normalized by the square of one’s height (m2), before (pre), during (during), and after (post) sorafenib treatment, were calculated. Patients within the 20th percentile cutoffs for these indices were classified into the rapid depletion group and the effects of these values on survival were analyzed using the Kaplan-Meier analysis and Cox proportional-hazards model. Annualized depletion rates of SMI (ΔSMIpre: −3.5, ΔSMIduring: −3.5, ΔSMIpost: −8.0) and VATI (ΔVATIpre: −3.2, ΔVATIduring: −2.8, ΔVATIpost: −15.1) accelerated after the cancellation of sorafenib, whereas that of SATI (ΔSATIpre: −4.8, ΔSATIduring; −7.6, ΔSATIpost; −8.0) had already accelerated during sorafenib treatment. Patients with rapid depletion of ΔSATIduring experienced significantly worse survival rates (p < 0.001), and it was an independent predictor of survival (p = 0.009), together with therapeutic effect (p < 0.001). Rapid depletion of SAT during sorafenib treatment can be used to predict survival in patients with HCC.
Importance
The association between body composition (BC) and cancer outcomes is complex and incompletely understood. Previous research in non–small-cell lung cancer (NSCLC) has been limited to small, single-institution studies and yielded promising, albeit heterogeneous, results.
Objectives
To evaluate the association of BC with oncologic outcomes in patients receiving immunotherapy for advanced or metastatic NSCLC.
Design, Setting, and Participants
This comprehensive multicohort analysis included clinical data from cohorts receiving treatment at the Dana-Farber Brigham Cancer Center (DFBCC) who received immunotherapy given alone or in combination with chemotherapy and prospectively collected data from the phase 1/2 Study 1108 and the chemotherapy arm of the phase 3 MYSTIC trial. Baseline and follow-up computed tomography (CT) scans were collected and analyzed using deep neural networks for automatic L3 slice selection and body compartment segmentation (skeletal muscle [SM], subcutaneous adipose tissue [SAT], and visceral adipose tissue). Outcomes were compared based on baseline BC measures or their change at the first follow-up scan. The data were analyzed between July 2022 and April 2023.
Main Outcomes and Measures
Hazard ratios (HRs) for the association of BC measurements with overall survival (OS) and progression-free survival (PFS).
Results
A total of 1791 patients (878 women [49%]) with NSCLC were analyzed, of whom 487 (27.2%) received chemoimmunotherapy at DFBCC (DFBCC-CIO), 825 (46.1%) received ICI monotherapy at DFBCC (DFBCC-IO), 222 (12.4%) were treated with durvalumab monotherapy on Study 1108, and 257 (14.3%) were treated with chemotherapy on MYSTIC; median (IQR) ages were 65 (58-74), 66 (57-71), 65 (26-87), and 63 (30-84) years, respectively. A loss in SM mass, as indicated by a change in the L3 SM area, was associated with worse oncologic outcome across patient groups (HR, 0.59 [95% CI, 0.43-0.81] and 0.61 [95% CI, 0.47-0.79] for OS and PFS, respectively, in DFBCC-CIO; HR, 0.74 [95% CI, 0.60-0.91] for OS in DFBCC-IO; HR, 0.46 [95% CI, 0.33-0.64] and 0.47 [95% CI, 0.34-0.64] for OS and PFS, respectively, in Study 1108; HR, 0.76 [95% CI, 0.61-0.96] for PFS in the MYSTIC trial). This association was most prominent among male patients, with a nonsignificant association among female patients in the MYSTIC trial and DFBCC-CIO cohorts on Kaplan-Meier analysis. An increase of more than 5% in SAT density, as quantified by the average CT attenuation in Hounsfield units of the SAT compartment, was associated with poorer OS in 3 patient cohorts (HR, 0.61 [95% CI, 0.43-0.86] for DFBCC-CIO; HR, 0.62 [95% CI, 0.49-0.79] for DFBCC-IO; and HR, 0.56 [95% CI, 0.40-0.77] for Study 1108). The change in SAT density was also associated with PFS for DFBCC-CIO (HR, 0.73; 95% CI, 0.54-0.97). This was primarily observed in female patients on Kaplan-Meier analysis.
Conclusions and Relevance
The results of this multicohort study suggest that loss in SM mass during systemic therapy for NSCLC is a marker of poor outcomes, especially in male patients. SAT density changes are also associated with prognosis, particularly in female patients. Automated CT-derived BC measurements should be considered in determining NSCLC prognosis.
