Adiposity and myosteatosis are prognostic biomarkers in advanced HCC patients receiving immunotherapy

Background and purpose: Immune checkpoint inhibitor (ICI)-based treatments have become the standard first-line therapy for patients with advanced hepatocellular carcinoma (HCC). Despite significant improvements with respect to the previously established standard sorafenib, response rates remain low at around 30%. Human metabolic phenotypes can modulate inflammation and tumor immunosurveillance. This study aimed to characterize metabolic states of patients with advanced HCC treated with ICI and assess their impact on clinical outcomes, potentially identifying novel prognostic biomarkers.

Methods: This observational, retrospective study collected data from a single center in Germany (LMU University Hospital Munich). Baseline body composition markers including BMI (<25 vs.≥25), visceral fat (high vs. low, based on median), and muscle density as a correlate of myosteatosis (yes vs. no, using Martin’s cut-offs), were assessed from CT scans at the L3 vertebral level. Markers were correlated with patient survival and analyzed using log-rank test.

Results: A total of 146 patients with unresectable HCC treated with ICI were included. BMI did not significantly impact overall and progression-free survival. Patients with higher levels of visceral fat showed prolonged survival (mOS 1038 days vs. 540 days, p=0.0142). Furthermore, the absence of myosteatosis emerged as strong prognostic marker for improved clinical outcomes (yes: mOS 240 days vs. no: mOS 709 days, p=0.0038).

Conclusions: Body composition parameters, such as visceral fat and myosteatosis, are significant prognostic markers in patients with advanced HCC treated with ICI. These findings might help to identify patients who could benefit from nutritional interventions to improve clinical outcomes.

Publication History

Article published online:
20 January 2025