Early post-treatment changes in body composition parameters are associated with overall survival and need of transplantation in cirrhotic patients with HCC undergoing locoregional treatments

Introduction Radiofrequency thermo-ablation (RFTA) and trans-arterial chemoembolization (TACE) represent effective therapeutic strategies for cirrhotic patients with hepatocellular carcinoma (HCC). It has been proposed that body composition parameters, particularly skeletal muscle index (SMI), may predict outcomes in patients with HCC. However, only few studies investigated the role of visceral (VATI) and subcutaneous adipose tissue index (SATI) on patients’ outcomes, and no data are available on the effect of their post-treatment changes in patients with HCC. Aims to investigate the impact of early post-treatment changes in body composition parameters on the overall-survival (OS) of cirrhotic patients with HCC and on the probability of being transplanted. Methods All cirrhotic patients with HCC treated for the first time with TACE or RFTA from 2012 to 2021 were retrospectively enrolled. Early changes of body composition (SMI, SATI and VATI) were extrapolated from abdominal CT scan performed before and one month after treatment and expressed as DELTA, following the formula: (one-month value- pre-procedure value)/ elapsed time. OS and probability of being transplanted were investigated with Fine-Gray multivariate competing risk analysis considering, respectively, LT and HCC progression outside the LT criteria (up-to-seven) as competitive risk events. Results 189 patients were enrolled, 132 undergoing TACE and 57 RFTA. In the multivariate analysis, across the entire population, the early decrease of VATI (DELTA-VATI negative) one month after treatment was associated to a increased risk of death (SHR=1.636; 95.0% CI=1.230-1.979; P=0.018), adjusting for age, MELDNa, Up-to-seven status and DELTA-SMI. In a sub-analysis, conducted considering only patients potentially eligible for LT, the early decrease in SMI (DELTA-SMI negative), but not in VATI was significantly associated to the need for LT (SHR=5.155; 95.0% CI=4.212-6.098; P<0.0001). Conclusions early body composition parameters post-treatment changes are useful in identifying cirrhotic patients with HCC at increased risk of death or need of LT.