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Fat-free muscle area measured by magnetic resonance imaging predicts overall survival of patients undergoing radioembolization of colorectal cancer liver metastases

  • Oncology
  • Published:
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Abstract

Objectives

To investigate the clinical potential of fat-free muscle area (FFMA) to predict outcome in patients with liver-predominant metastatic colorectal cancer (mCRC) undergoing radioembolization (RE) with 90Yttrium microspheres.

Methods

Patients with mCRC who underwent RE in our center were included in this retrospective study. All patients received liver magnetic resonance imaging including standard T2-weighted images. The total erector spinae muscle area and the intramuscular adipose tissue area were measured at the level of the origin of the superior mesenteric artery and subtracted to calculate FFMA. Cutoff values for definition of low FFMA were 3644 mm2 in men and 2825 mm2 in women. The main outcome was overall survival (OS). For survival analysis, the Kaplan-Meier method and Cox regressions comparing various clinic-oncological parameters which potentially may affect OS were performed.

Results

Seventy-seven patients (28 female, mean age 60 ± 11 years) were analyzed. Mean time between MRI and the following RE was 17 ± 31 days. Median OS after RE was 178 days. Patients with low FFMA had significantly shortened OS compared to patients with high FFMA (median OS: 128 vs. 273 days, p = 0.017). On multivariate Cox regression analysis, OS was best predicted by FFMA (hazard ratio (HR) 2.652; p < 0.001). Baseline bilirubin (HR 1.875; p = 0.030), pattern of tumor manifestation (HR 1.679; p = 0.001), and model of endstage liver disease (MELD) score (HR 1.164; p < 0.001) were also significantly associated with OS.

Conclusions

FFMA was associated with OS in patients receiving RE for treatment of mCRC and might be a new prognostic biomarker for survival prognosis.

Key Points

• Fat-free muscle area (FFMA) as a measure of lean muscle area predicts survival in metastatic colorectal liver cancer following radioembolization.

• FFMA can easily be assessed from routine pre-interventional liver magnetic resonance imaging.

• FFMA might be a new promising biomarker for assessment of sarcopenia.

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Abbreviations

ATA:

Adipose tissue area

CRC:

Colorectal cancer

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group performance status

FFMA:

Fat-free muscle area

mCRC:

Liver-predominant metastatic colorectal cancer

MELD:

Model of endstage liver disease

MRI:

Magnetic resonance imaging

OS:

Overall survival

PDFF:

Proton density fat fraction

RE:

Radioembolization

SMI:

Skeletal muscle index

TIPS:

Transjugular intrahepatic portosystemic shunt

TMA:

Total muscle area

Y-90:

90Yttrium microspheres

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Anton Faron, Claus C. Pieper, Frederic C. Schmeel, Alois M. Sprinkart, Daniel L. R. Kuetting, Hans H. Schild, Carsten Meyer, Daniel Thomas & Julian A. Luetkens

  2. Department of Medical Biometry, Informatics, and Epidemiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Rolf Fimmers

  3. Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Jonel Trebicka

  4. European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain

    Jonel Trebicka

  5. Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Jonel Trebicka

  6. Institute for Bioengineering of Catalonia, Barcelona, Spain

    Jonel Trebicka

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  1. Anton Faron
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Corresponding author

Correspondence to Julian A. Luetkens.

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Guarantor

The scientific guarantor of this publication is PD Dr. Julian A. Luetkens.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: C.M. is a consultant for SIRTEX Medical; C.C.P. received speakers’ fees from Philips Healthcare.

Statistics and biometry

One of the authors (R.F.) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• performed at one institution

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Faron, A., Pieper, C.C., Schmeel, F.C. et al. Fat-free muscle area measured by magnetic resonance imaging predicts overall survival of patients undergoing radioembolization of colorectal cancer liver metastases. Eur Radiol 29, 4709–4717 (2019). https://doi.org/10.1007/s00330-018-5976-z

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  • DOI: https://doi.org/10.1007/s00330-018-5976-z

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