Visceral adiposity increases risk for hepatocellular carcinoma in male patients with cirrhosis and recurrence after liver transplant

ABSTRACT

Visceral adipose tissue (VAT) is a metabolically active organ, associated with higher risk of malignancies. We aimed to evaluate if VAT is associated with the risk of hepatocellular carcinoma (HCC) in patients presenting with cirrhosis as well as HCC recurrence after liver transplantation (LT). Cirrhotic patients (n=678; 457 males) who were assessed for LT (289 with HCC) were evaluated for body composition analysis. Patients who underwent LT (n=247, 168 males) were subsequently evaluated for body composition, and 96 of these patients (78 males) had HCC. VAT, subcutaneous (SAT) and total adipose tissues (TAT) were quantified by computed tomography at the level of the 3^rd lumbar vertebra and reported as indexes (cross-sectional area normalized for height [cm²/m²]). At the time of LT assessment, VAT index (VATI) was higher in male patients with HCC compared to non-HCC patients (75±3 vs. 60±3 cm²/m², P=0.001). VATI, and SAT and TAT indexes were higher in male patients with HCC compared to non-HCC patients. By multivariate analysis, male patients with VATI ≥65 cm²/m² had a higher risk of HCC (HR 1.90, 95% CI 1.31-2.76, P=0.001). In male patients with HCC who underwent LT, a VATI ≥65 cm²/m² adjusted for Milan criteria was independently associated with higher risk of HCC recurrence (HR 5.34, 95% CI 1.19-23.97, P=0.03). Conclusions: High VATI is a novel and independent risk factor for HCC in male patients with cirrhosis, and for recurrence of HCC after LT. This article is protected by copyright. All rights reserved.

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