Low Visceral Adipose Tissue Predicts the Outcome of Neoadjuvant Chemotherapy for Colorectal Liver Metastases: A Multicentre Real-World Study

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-04-01 DOI:10.1002/jcsm.13785

Yizhen Chen, Hangdong Jia, Rong Ye, Zhenyuan Zhou, Weijie Chen, Ming Zheng, Yuanyuan Zheng

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Abstract

Background

Visceral obesity (VO), associated with excessive visceral adipose tissue (VAT), has been extensively studied in cancer. However, whether low VAT can predict the prognosis of colorectal liver metastases (CRLM) undergoing neoadjuvant chemotherapy (NAC) remains unknown.

Methods

This multicentre real-world cohort study analysed data from initially resectable CRLM patients who received NAC. The predictive effect of VAT on progression-free survival (PFS) and overall survival (OS) was evaluated using restricted cubic splines (RCS). VAT was categorized into low/normal VAT and VO groups using X-tile. The prognostic differences were further assessed through Kaplan–Meier (KM) analysis. The impact of changes in VAT (ΔVAT) after NAC was evaluated.

Results

Among 1524 CRLM patients, 1105 patients (72.51%) were under 65 years old, with a median VAT of 84.00 (36.24–148.00) cm². Of all patients, 804 (52.76%) were female. A U-shaped nonlinear relationship was observed between VAT and both PFS/OS (p < 0.001). Compared with the normal VAT, both low VAT and VO groups showed worsened PFS and OS (p < 0.05). The 3-year PFS rate was 31.6%, 69.0% and 42.0% in the low, normal VAT and VO groups (p < 0.05). The 3-year OS rate was 76.4%, 88.9% and 79.4% in the low, normal VAT and VO groups (p < 0.05). There was also a nonlinear relationship between VAT and NAC-related adverse events, objective response rate and postoperative complications (p < 0.001). An increase in ΔVAT in the low VAT group was associated with better PFS and OS (p < 0.05). In the VO group, both increases and decreases in ΔVAT were associated with worsened PFS and OS (p < 0.05).

Conclusions

This study is the first to reveal that low VAT and VO can predict PFS and OS in CRLM patients undergoing NAC. Baseline VAT and ΔVAT may serve as important indicators for risk stratification and personalized treatment in CRLM patients.

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低内脏脂肪组织预测结直肠癌肝转移新辅助化疗的结果：一项多中心真实世界研究

与内脏脂肪组织（VAT）过多相关的内脏肥胖（VO）在癌症中得到了广泛的研究。然而，低VAT是否能预测新辅助化疗（NAC）的结直肠癌肝转移（CRLM）的预后尚不清楚。方法：这项多中心真实世界队列研究分析了最初接受NAC的可切除的CRLM患者的数据。使用限制性三次样条（RCS）评估VAT对无进展生存期（PFS）和总生存期（OS）的预测作用。使用X-tile将增值税分为低/正常增值税和VO组。通过Kaplan-Meier （KM）分析进一步评估预后差异。评估了NAC后增值税变化的影响（ΔVAT）。结果1524例CRLM患者中，65岁以下1105例（72.51%），增值率中位数为84.00 (36.24-148.00)cm2。其中女性804例（52.76%）。在VAT和PFS/OS之间观察到u形非线性关系（p < 0.001）。与VAT正常组相比，低VAT组和VO组PFS和OS均恶化（p < 0.05）。低、正常和VO组3年PFS率分别为31.6%、69.0%和42.0% （p < 0.05）。低、正常和VO组3年OS率分别为76.4%、88.9%和79.4% （p < 0.05）。VAT与nac相关不良事件、客观缓解率和术后并发症之间也存在非线性关系（p < 0.001）。低增值组ΔVAT升高与PFS和OS改善相关（p < 0.05）。VO组ΔVAT升高和降低均与PFS和OS恶化相关（p < 0.05）。结论本研究首次揭示了低VAT和VO可以预测行NAC的CRLM患者的PFS和OS。基线VAT和ΔVAT可作为CRLM患者风险分层和个性化治疗的重要指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.

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