Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Lean body mass index is a marker of advanced tumor features in patients with hepatocellular carcinoma
Andrew Scott deLemos, Jing Zhao, Milin Patel, Banks Kooken, Karan Mathur, Hieu Minh Nguyen, Areej Mazhar, Maggie McCarter, Heather Burney, Carla Kettler, Naga Chalasani, Samer Gawrieh
Andrew Scott deLemos, Milin Patel, Banks Kooken, Department of Medicine, Atrium Health, Charlotte, NC 28204, United States
Jing Zhao, Maggie McCarter, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC 28204, United States
Karan Mathur, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Hieu Minh Nguyen, Center for Health System Sciences (CHASSIS), Atrium Health, Charlotte, NC 28204, United States
Areej Mazhar, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
Heather Burney, Carla Kettler, Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Naga Chalasani, Samer Gawrieh, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Author contributions: deLemos AS, Gawrieh S, and Chalasani N conceived the study, analyzed data, and contributed to draft and final manuscript preparation; Zhao J, and Nguyen HM provided statistical analysis, critical appraisal of data, and manuscript editing; Patel M, Kooken B, Mathur K, Mazhar A, Burney H, and Kettler C assisted with tumor registry data entry and maintenance of database; McCarter M assisted with statistical analysis.
Supported by in part David W Crabb Professorship Endowment at Indiana University School of Medicine and an intramural grant from the Atrium Health Center for Outcomes Research and Evaluation (CORE) (to deLemos AS).
Institutional review board statement: Each participating site had local Institutional Review Board approval to conduct the study.
Informed consent statement: This study was retrospective and did not have any direct patient contact and was completely deidentified.
Conflict-of-interest statement: Dr. Gawrieh consulting: TransMedics, Pfizer, research grant support: Cirius, Galmed and Zydus. Dr. Chalasani had paid consulting activities with following companies in last 12 months: Abbvie, Madrigal, Galectin, Zydus, Boehringer-Ingelheim, and Altimmune. He and his institution receive research funding from DSM, Exact Sciences, and Galectin. The remaining authors have no conflicts of interests to declare in the last 12 months.
Data sharing statement: A data sharing agreement was established between Atrium Health and Indiana University School of Medicine for the purpose of compiling a de-identified patient registry.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Andrew Scott deLemos, MD, Associate Professor, Department of Medicine, Atrium Health, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, United States. andrew.delemos@atriumhealth.org
Received: November 15, 2023
Peer-review started: November 15, 2023
First decision: November 27, 2023
Revised: December 31, 2023
Accepted: February 23, 2024
Article in press: February 23, 2024
Published online: March 27, 2024
ARTICLE HIGHLIGHTS
Research background
This study examines a large cohort of patients diagnosed with hepatocellular carcinoma (HCC) at two academic medical centers where liver transplantation is offered. Extensive data collection on patient and tumor variables were obtained to investigate the relationship between body mass index (BMI) classification and outcomes of patients with HCC.
Research motivation
The motivation for our research study is to explore how different BMI strata impact survival in patients with HCC.
Research objectives
It is apparent that a lean BMI in patients at the time of HCC diagnosis reflects advanced tumor burden but is not independently associated with worse survival.
Research methods
Patient and tumor characteristics were compared according to BMI < 25 kg/m2 (lean), BMI 25-29.9 kg/m2 (overweight), and BMI ≥ 30 kg/m2. The Kaplan-Meier method was used to estimate survival by BMI categories. A multivariable model was performed to investigate risk factors (including the three BMI strata) associated with survival following HCC diagnosis.
Research results
Our research demonstrates interesting differences when comparing patients across BMI categories. For example, women with HCC were more likely to be in a higher BMI classification than men. Chronic hepatitis C infection was by far the most common reason for chronic liver disease in our cohort, and achieving sustained virologic response, not unexpectedly was associated with improved survival. We did not see significant differences in the Child-Pugh class or model for end stage liver disease scores according to the three different BMI. We did not see a survival difference by BMI class in our large cohort of 286 non-cirrhotic HCC cases patients.
Research conclusions
The relevant conclusion that one can draw from this study is the importance of identifying patients early in their presentation as our results confirm well established risk factors for reduced survival in patients with HCC trump the perceived protection of the "obesity paradox".
Research perspectives
The future research in this field needs to focus on improving patient access to screening for HCC to prevent a delay in diagnosis.
