Hamaguchi Yuhei, Kaido Toshimi, Okumura Shinya, Kobayashi Atsushi, Shirai Hisaya, Yao Siyuan, Yagi Shintaro, Kamo Naoko, Seo Satoru, Taura Kojiro, Okajima Hideaki, Uemoto Shinji
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Liver Cancer. 2019 Mar;8(2):92-109. doi: 10.1159/000488779. Epub 2018 Jun 5.
Visceral adiposity, defined as a high visceral-to-subcutaneous adipose tissue area ratio (VSR), has been shown to be associated with poor outcomes in several cancers. However, in the surgical field, the significance of visceral adiposity remains controversial. The present study investigated the impact of visceral adiposity as well as sarcopenic factors (low muscularity) on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).
This retrospective study analyzed data from 606 patients undergoing hepatectomy for HCC at our institution between April 2005 and March 2016. Using preoperative plain computed tomography imaging at the level of the third lumbar vertebra, visceral adiposity, skeletal muscle mass, and muscle quality were evaluated by the VSR, skeletal muscle mass index (SMI), and intramuscular adipose tissue content (IMAC), respectively. The impact of these parameters on outcomes after hepatectomy for HCC was analyzed.
The overall survival rate was significantly lower among patients with a high VSR ( < 0.001) than among patients with a normal VSR. Similarly, the recurrence-free survival rate was significantly lower among patients with a high VSR ( = 0.016). A high VSR, low SMI, and high IMAC contributed to an increased risk of death ( < 0.001) and HCC recurrence ( < 0.001) in an additive manner. Multivariate analysis showed that not only preoperative low muscularity but also visceral adiposity was a significant risk factor for mortality (hazard ratio [HR] = 1.566, < 0.001) and HCC recurrence (HR = 1.329, = 0.020) after hepatectomy for HCC.
Preoperative visceral adiposity, as well as low muscularity, was closely related to poor outcomes after hepatectomy for HCC. It is crucial to establish a new strategy including perioperative nutritional interventions with rehabilitation for better outcomes after hepatectomy for HCC.
内脏脂肪过多定义为高内脏与皮下脂肪组织面积比（VSR），已被证明与多种癌症的不良预后相关。然而，在外科领域，内脏脂肪过多的意义仍存在争议。本研究调查了内脏脂肪过多以及肌肉减少因素（低肌肉量）对肝细胞癌（HCC）肝切除术患者预后的影响。
这项回顾性研究分析了2005年4月至2016年3月期间在我院接受HCC肝切除术的606例患者的数据。使用第三腰椎水平的术前普通计算机断层扫描成像，分别通过VSR、骨骼肌质量指数（SMI）和肌内脂肪组织含量（IMAC）评估内脏脂肪过多、骨骼肌质量和肌肉质量。分析这些参数对HCC肝切除术后预后的影响。
VSR高的患者总生存率显著低于VSR正常的患者（<0.001）。同样，VSR高的患者无复发生存率也显著更低（=0.016）。高VSR、低SMI和高IMAC以累加方式增加了死亡风险（<0.001）和HCC复发风险（<0.001）。多变量分析显示，对于HCC肝切除术后的死亡率（风险比[HR]=1.566，<0.001）和HCC复发（HR=1.329，=0.020），不仅术前低肌肉量，而且内脏脂肪过多都是显著的危险因素。
术前内脏脂肪过多以及低肌肉量与HCC肝切除术后的不良预后密切相关。建立一种新策略至关重要，该策略包括围手术期营养干预和康复，以改善HCC肝切除术后的预后。
