{ "abstract": "Purpose: Nutritional status significantly impacts the prognosis of patients with hepatocellular carcinoma (HCC). Computed tomography (CT) has become a key tool for assessing body composition (BC), with abnormal patterns increasingly linked to reduced survival. However, BC is dynamic and may change during treatment, potentially affecting treatment outcomes. This study explores how BC affects survival and dose-limiting toxicities (DLTs) in patients with advanced HCC receiving first-line treatment, as well as changes in BC over the course of treatment.\n\nMethods: This retrospective study included patients with advanced HCC who received first-line systemic therapy. The Lumbar skeletal muscle index and adipose tissue indices were measured via CT analysis at baseline and at the best response. Cox regression and generalized linear models were used for analysis.\n\nResults: The study included 113 patients treated with tyrosine kinase inhibitors (70%) or immune checkpoint inhibitors (30%), primarily atezolizumab and bevacizumab. Univariable analyses identified a high visceral-to-subcutaneous adipose tissue ratio (VSR) and muscle depletion as predictors of poor survival. The association between elevated VSR and reduced survival was further confirmed in bivariable models adjusted for relevant prognostic factors. Elevated VSR was also associated with an increased incidence of DLT (hazard ratio [HR]: 1.16, 95% CI: 1.08–1.26, p < 0.001). Although most patients experienced muscle and fat loss during treatment, VSR remained stable. At the time of best radiologic response, high VSR remained associated with poorer survival outcomes (HRs for progression-free survival and overall survival: 1.37 and 1.12, respectively; p < 0.001).\n\nConclusions: Although validation in larger studies is needed, our study suggests that VSR is a robust, time-stable predictor of survival and toxicity in patients with advanced HCC.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00432-026-06570-1.", "abstract_shown": true, "affiliations": [ "Department of Internal Medicine and Medical Therapy, University of Pavia, Corso Strada Nuova 65, 27100 Pavia, Italy", "Department of Oncology, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy", "Department of Oncology, IRCCS San Raffaele Hospital, Milan, Italy", "Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy", "BERD Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy", "Clinical Nutrition and Dietetics Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy", "Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy", "Diagnostic Imaging and Radiotherapy Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy", "Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy", "Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy", "Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy" ], "article_type": "research article", "arxiv": null, "author_total": 23, "authors": [ { "affs": [ 0, 1 ], "name": "Salvatore Corallo", "orcid": "0000-0002-6672-0233" }, { "affs": [ 2, 3 ], "name": "Margherita Rimini" }, { "affs": [ 0 ], "name": "Carlo Paolo Scolari" }, { "affs": [ 4 ], "name": "Catherine Klersy" }, { "affs": [ 5 ], "name": "Elisa Mattavelli" }, { "affs": [ 6, 7 ], "name": "Chandra Bortolotto" }, { "affs": [ 6 ], "name": "Salvatore Dierna" }, { "affs": [ 4 ], "name": "Giulia Gambini" }, { "affs": [ 8, 9 ], "name": "Amanda Casirati" }, { "affs": [ 0, 1 ], "name": "Francesco Agustoni" }, { "affs": [ 1 ], "name": "Angioletta Lasagna" }, { "affs": [ 1 ], "name": "Silvia Chiellino" }, { "affs": [ 3 ], "name": "Silvia Foti" }, { "affs": [ 2, 3 ], "name": "Federico Rossari" }, { "affs": [ 3 ], "name": "Silvia Camera" }, { "affs": [ 1 ], "name": "Francesco Serra" }, { "affs": [ 1 ], "name": "Anna Pagani" }, { "affs": [ 1 ], "name": "Sofia Marino" }, { "affs": [ 6, 7 ], "name": "Lorenzo Preda" }, { "affs": [ 5, 10 ], "name": "Riccardo Caccialanza" }, { "affs": [ 0, 1 ], "name": "Paolo Pedrazzoli" }, { "affs": [ 5 ], "name": "Emanuele Cereda" }, { "affs": [ 2, 3 ], "name": "Andrea Casadei-Gardini" } ], "bibtex": "https://research.draconitic.com/paper/c6ym0hd4xrnv6.bib", "cited_by": 0, "doi": "10.1007/s00432-026-06570-1", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731561/", "id": "c6ym0hd4xrnv6", "issns": [ "0171-5216", "1432-1335" ], "landing_url": "https://doi.org/10.1007/s00432-026-06570-1", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research" ], [ "openalex", "2721|Hepatocellular Carcinoma Treatment and Prognosis" ] ], "openalex": "W7172480983", "pdf_url": null, "pmcid": "PMC13731561", "pmid": "42975725", "published": "2026-08-05", "publisher": "Springer", "ris": "https://research.draconitic.com/paper/c6ym0hd4xrnv6.ris", "sources": [ { "first_seen": "2026-11-08T12:21:44Z", "native_id": "PMC13731561", "source": "pmc", "url": "https://doi.org/10.1007/s00432-026-06570-1" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis", "subfield": "general" } ], "title": "Visceral-to-subcutaneous fat ratio is a time-stable predictor of survival and toxicity in advanced hepatocellular carcinoma", "title_text": "Visceral-to-subcutaneous fat ratio is a time-stable predictor of survival and toxicity in advanced hepatocellular carcinoma", "type": "peer-reviewed", "updated_at": "2026-11-08T12:21:44Z", "url": "https://research.draconitic.com/paper/c6ym0hd4xrnv6", "venue": "Journal of Cancer Research and Clinical Oncology", "versions": [] }