Body Composition Predicts Survival in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Neehar D. Parikh, Peng Zhang, Amit G. Singal, Brian A. Derstine, Venkat Krishnamurthy, Pranab Barman, Akbar K. Waljee, Grace L. Su

The prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is often uncertain. We aimed to utilize analytic morphomics, a high-throughput imaging analysis, to assess if body composition is predictive of post-TACE survival. We included patients from a single center (Ann Arbor VA) who had TACE as the primary treatment for HCC and had a pre-treatment CT scans. Univariate analysis and multivariate conditional inference tree analysis were utilized to identify the morphomic characteristics predictive of one-year survival. were validated in an external cohort (University of Michigan Health System) of HCC patients who underwent TACE as their primary treatment. In the 75 patients in the derivation cohort, median survival was 439 (IQR: 377-685) days from receipt of TACE, with 1-year survival of 61%. Visceral fat density (VFD) was the only morphomic factor predictive of overall and 1-year survival (p<0.001). Patients with VFD above the 56th percentile had a 1-year survival of 39% vs. 78% for those below the 56th percentile. VFD also correlated with 1-year survival in the external validation cohort (44% vs. 72%, p<0.001). In a secondary analysis, patients with higher VFD were significantly more likely to experience hepatic decompensation after TACE (p<0.001). VFD served as an objective predictor of mortality in patients undergoing TACE, possibly through its ability to predict hepatic decompensation. VFD may serve as a radiographic biomarker in predicting TACE outcomes.