Early Change in Subcutaneous Fat Attenuation on Follow-up CT Provides Prognostic Information Beyond AFP in Advanced Hepatocellular Carcinoma During Immunotherapy.
Journal
Academic Radiology
ISSN
1878-4046
Date Issued
2026-08-11
Author(s)
Chen, Po-Yi
Deng, Shyh-Bang
Hsu, Chiun
Hsu, Chih-Hung
Shao, Yu-Yun
Abstract
Rationale and Objectives To determine whether early CT-derived body composition changes provide prognostic information beyond AFP dynamics in patients with advanced hepatocellular carcinoma (HCC) receiving immunotherapy. Materials and Methods This retrospective study included patients with advanced HCC who underwent baseline and early follow-up contrast-enhanced CT. Body composition was assessed on portal venous phase CT images at the L3 level. A clinical trial cohort was used for model development, and an independent real-world cohort was used for validation. Exploratory analyses evaluated longitudinal changes in CT-derived body composition, after which prognostic models were sequentially constructed using baseline clinical factors, AFP change, and subcutaneous adipose tissue (SAT) attenuation change. Progression-free survival (PFS) and overall survival (OS) were evaluated. Results Among 205 patients with paired baseline and first on-treatment CT examinations, 200 with paired AFP measurements were included in model comparisons. AFP change improved prognostic assessment for both PFS and OS in the clinical trial and real-world cohorts. SAT attenuation change added little for PFS but provided additional prognostic information for OS in both cohorts. Adding SAT attenuation change increased the C-index for OS from 0.705 to 0.720 in the clinical trial cohort (P < 0.001) and from 0.706 to 0.726 in the real-world cohort (P = 0.031). Overall, AFP appeared to reflect early tumor-related change, whereas SAT attenuation change provided complementary information more closely related to survival. Conclusion Early SAT attenuation change on follow-up CT was associated mainly with OS and provided modest incremental prognostic information beyond AFP dynamics.
Subjects
Body composition
Hepatocellular carcinoma
Immunotherapy
Survival
Tomography, computed
Publisher
Elsevier Inc.
Type
journal article