Skeletal muscle radiodensity and visceral adipose tissue index are associated with survival in renal cell cancer – A multicenter population-based cohort study

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 41; no. 1; pp. 131 - 143
• Main Authors: Maurits, Jake S.F., Sedelaar, J.P. Michiel, Mulders, Peter F.A., Aben, Katja K.H., Kiemeney, Lambertus A.L.M., Vrieling, Alina
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2022
• Subjects: Aged; Body Composition; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Cohort Studies; Densitometry - statistics & numerical data; Female; Health Status Indicators; Humans; Intra-Abdominal Fat - diagnostic imaging; Intra-Abdominal Fat - pathology; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Lumbar Vertebrae - diagnostic imaging; Male; Middle Aged; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - pathology; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Renal cell cancer; Subcutaneous Fat - diagnostic imaging; Subcutaneous Fat - pathology; Survival; Tomography, X-Ray Computed; Renal cell cancer; Survival; Body composition
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2021.11.012

Body composition has been associated with disease outcome in several cancer types. Results for localized and metastatic renal cell cancer (RCC) are limited and inconsistent. Our aim was to examine the association between body composition and survival in RCC.
We conducted a population-based historical cohort study including patients diagnosed with RCC from 2008 to 2012. Diagnostic Computed Tomography images at the third lumbar vertebra (L3) were assessed for skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI). Clinical data was retrieved from medical records. Multivariable Cox regressions with restricted cubic splines were used to determine hazard ratios (HRs) and 95% confidence intervals (95%CIs) for 10-unit increases in body composition features with overall survival (OS) and recurrence-free survival (RFS).
We included 719 stage I-III (of whom 254 (35.3%) died and 148 (21.9%) experienced recurrence) and 320 stage IV RCC patients (of whom 298 (93.1%) died). Median follow-up was 6.35 years (interquartile range; 1.41–8.23). For stage I-III, higher SMD was associated with better OS (men: HR 0.86; 95% CI 0.68–1.08; women: HR 0.69; 95% CI 0.50–0.95). Lower compared to median VATI was associated with worse OS for both men (HR 1.38; 95%CI 1.05–1.83 for VATI = 25) and women (HR 1.67; 95%CI 1.01–2.78 for VATI = 20). For stage IV, higher SMD and higher VATI were associated with better OS among men (HR 0.74; 95% CI 0.59–0.94 and HR 0.93; 95% CI 0.88–0.99, respectively). Results for women were similar but non-significant. No statistically significant associations were found for SMI or SATI.
Higher SMD and higher VATI were marginally associated with better survival in RCC patients and might be useful for better prognostication. However, the added value to current prognostic scores needs to be investigated.