The Effect Of CT-Based Human Muscle And Adipose Tissue Content On TACE Refractoriness In Hepatocellular Carcinoma

Background and Objective: By combining the clinical data of patients with hepatocellular carcinoma and CT-based human muscle and adipose tissue parameters,this study aimed to investigate the risk factors for refractory development after transcatheter arterial chemoembolization(TACE)in patients with hepatocellular carcinoma,to establish a clinical and body composition prediction model,and then to try to predict patients at high risk of refractory TACE.Methods: This study retrospectively collected 128 patients diagnosed with hepatocellular carcinoma and treated with TACE at the Third Xiangya Hospital of Central South University and Hunan Cancer Hospital from June 2013 to October 2021.TACE refractoriness was determined according to the Japanese Society of Hepatology(JSH)guidelines.Of all patients,89 patients(approximately 70%)were assigned to the training cohort and the remaining 39 patients(approximately 30%)were assigned to the validation cohort.The areas of skeletal muscle(SM),subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),and intermuscular adipose tissue(IMAT)were measured on CT images at the level of the third lumbar vertebra(L3)and normalized by the square of height to calculate skeletal muscle index(SMI),SAT index(SATI),VAT index(VATI),and IMAT index(IMATI).The area ratio(VSR)of VAT to SAT and the total adipose tissue index(TATI)were also calculated.Univariate and multifactor logistic regression analyses were performed on clinical data and body composition parameters to find independent risk factors affecting the refractoriness of TACE in patients with hepatocellular carcinoma,and clinical,body composition and combined prediction models were established and finally validated in a validation cohort,and the performance of each prediction model was evaluated using the subject operating curve(ROC).Results: The training cohort included 89 patients,of whom 39(43.8%)were TACE-refractory,and the test set included 39 patients,of whom 17(43.6%)were TACE-refractory.The results of multifactorial logistic regression showed that baseline maximal tumor diameter,VSR were independent risk factors for TACE refractory.The clinical prediction model was constructed using maximal tumor diameter with an AUC value of0.865 in the training cohort and 0.749 in the validation cohort.the body composition prediction model was constructed using VSR with an AUC value of 0.894 in the training cohort and 0.810 in the validation cohort.the sensitivity of the combined model was 0.925 in the training cohort at the optimal cut-off point with a sensitivity of 96.0% and specificity of 79.5%,and the validation cohort AUC value of 0.885 had a sensitivity of 77.3%and specificity of 94.1%,which was statistically different compared to the clinical model alone(P<0.01).Calibration curves showed good agreement between predicting the occurrence of TACE refractoriness and the true situation.Decision curves showed that the net clinical benefit of the combined clinical-physical component model was higher than that of both the clinical and physical component models alone over a wide range of threshold probability intervals.Conclusion: The patient’s preoperative maximum tumor diameter and VSR are independent risk factors for predicting TACE refractoriness in patients with hepatocellular carcinoma.The body composition model,clinical model and combined model can be used to predict the patient’s risk of TACE refractoriness preoperatively,and the combined model has better predictive performance than the body composition model and clinical model alone,which helps clinicians to choose the optimal treatment for hepatocellular carcinoma.