Visceral-to-subcutaneous fat ratio is a time-stable predictor of survival and toxicity in advanced hepatocellular carcinoma
11 affiliations
- 1Department of Internal Medicine and Medical Therapy, University of Pavia, Corso Strada Nuova 65, 27100 Pavia, Italy
- 2Department of Oncology, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 3Department of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
- 4Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
- 5BERD Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 6Clinical Nutrition and Dietetics Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 7Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- 8Diagnostic Imaging and Radiotherapy Unit, Comprehensive Cancer Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 9Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- 10Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- 11Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
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.
Methods: 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.
Results: 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).
Conclusions: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00432-026-06570-1.
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BibTeX
@article{corallo2026visceraltosubcutaneous,
title = {{Visceral-to-subcutaneous fat ratio is a time-stable predictor of survival and toxicity in advanced hepatocellular carcinoma}},
author = {Salvatore Corallo and Margherita Rimini and Carlo Paolo Scolari and Catherine Klersy and Elisa Mattavelli and Chandra Bortolotto and Salvatore Dierna and Giulia Gambini and Amanda Casirati and Francesco Agustoni and Angioletta Lasagna and Silvia Chiellino and Silvia Foti and Federico Rossari and Silvia Camera and Francesco Serra and Anna Pagani and Sofia Marino and Lorenzo Preda and Riccardo Caccialanza and Paolo Pedrazzoli and Emanuele Cereda and Andrea Casadei-Gardini},
journal = {Journal of Cancer Research and Clinical Oncology},
year = {2026},
month = aug,
doi = {10.1007/s00432-026-06570-1},
url = {https://doi.org/10.1007/s00432-026-06570-1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Visceral-to-subcutaneous fat ratio is a time-stable predictor of survival and toxicity in advanced hepatocellular carcinoma
AU - Salvatore Corallo
AU - Margherita Rimini
AU - Carlo Paolo Scolari
AU - Catherine Klersy
AU - Elisa Mattavelli
AU - Chandra Bortolotto
AU - Salvatore Dierna
AU - Giulia Gambini
AU - Amanda Casirati
AU - Francesco Agustoni
AU - Angioletta Lasagna
AU - Silvia Chiellino
AU - Silvia Foti
AU - Federico Rossari
AU - Silvia Camera
AU - Francesco Serra
AU - Anna Pagani
AU - Sofia Marino
AU - Lorenzo Preda
AU - Riccardo Caccialanza
AU - Paolo Pedrazzoli
AU - Emanuele Cereda
AU - Andrea Casadei-Gardini
PY - 2026
DA - 2026/08/05
JO - Journal of Cancer Research and Clinical Oncology
DO - 10.1007/s00432-026-06570-1
UR - https://doi.org/10.1007/s00432-026-06570-1
AB - 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. Methods: 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. Results: 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). Conclusions: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00432-026-06570-1.
SN - 0171-5216
SN - 1432-1335
ER -