Work

Muscle and tissue radiodensity matter: Automated CT-based body composition analysis predicts survival in hepatocellular carcinoma patients undergoing degradable starch microspheres transarterial chemoembolization (DSM-TACE)

Year: 2026

Type: article

Abstract: Background Transarterial chemoembolization with degradable starch microspheres (DSM-TACE) has emerged as an increasingly important and effective treatment for hepatocellular carcinoma (HCC); however, the impact of body composition on clinical outcomes remains unknown. Objectives This study aimed to assess the prognostic significance of pretreatment, fully automated 3D-volumetric computed tomography (CT)-based body composition analysis (BCA) in patients with HCC undergoing DSM-TACE. Design Retrospective single-center study. Methods A total of 137 patients were treated with repetitive DSM-TACE. BCA quantified the volumes and radiodensities of the skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and bone (B) using baseline abdominal CT scans. The maximally selected log-rank test was applied for the cutoff selection. Survival outcomes were analyzed using Kaplan-Meier curves and uni- and multivariate Cox proportional hazards models with hazard ratios (HR). Results The median overall survival (OS) of the cohort was 16.5 months. Multivariate analysis identified three BCA parameters as independent predictors of improved survival: a high SM/B ratio (HR: 0.44; p = 0.008), high SM radiodensity (HR: 0.26; p = 0.004), and low VAT radiodensity (HR: 0.20; p = 0.004). A cumulative risk score based on these independent factors (1 point per favorable factor) allowed for distinct survival stratification ( p < 0.0001), with median OS ranging from 34.4 months in the low-risk group (score 3) to 17.7, 10.1, and 2.8 months for scores of two to zero points (pairwise comparison p ≤ 0.016). Survival stratification remained statistically significant in both the Barcelona Clinic Liver Cancer (BCLC) stage B and C subgroups. Conclusion Fully automated CT-based quantification of body composition is a valuable tool for assessing survival in patients with HCC treated with DSM-TACE. The integration of the SM/B ratio and tissue radiodensities enable can improve personalized survival stratification within the BCLC B and C subgroups, warranting further validation and clinical integration evaluation.

Source: Therapeutic Advances in Medical Oncology

DOI: 10.1177/17588359261501121