Hepatobiliary & pancreatic diseases international : HBPD INT · 2026
Chronological change in subcutaneous adipose tissue radiodensity as a predictor of surgical outcome in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.
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Sugiura Ryo, Kuwatani Masaki, Noji Takehiro, Kawakubo Kazumichi, Nakanishi Yoshitsugu, Tanaka Kimitaka, Hirano Satoshi, Sakamoto Naoya
Аннотация
BACKGROUND: Subcutaneous adipose tissue (SAT) is among the components of body composition. SAT radiodensity (SATr) is an indirect surrogate marker of adipose tissue quality and is associated with a poor prognosis in various malignancies. The present study aimed to evaluate the association of chronological changes in SATr during the preoperative waiting period with postoperative overall survival (OS) in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.
METHODS: This study included patients with perihilar cholangiocarcinoma who underwent major hepatectomy and extrahepatic bile duct resection as curative treatment. SATr was evaluated using plain computed tomography images. The chronological changes in SATr were calculated as SATr at surgery minus SATr at diagnosis. SATr changes of > 0 or ≤ 0 Hounsfield units were defined as positive (P-SATr) or negative SATr changes (N-SATr), respectively. The primary outcome was postoperative OS according to the change in SATr. The prognostic factors for OS were also evaluated using a Cox proportional hazard model.
RESULTS: The study enrolled 104 patients, including 75 and 29 patients with P-SATr and N-SATr, respectively. P-SATr was associated with higher serum carcinoembryonic antigen levels and greater amount of adjusted blood loss during the operation. There were no significant differences in the in-hospital mortality and complication rates as well as postoperative hospital stay between the P-SATr and N-SATr groups. The median OS durations were 37.3 and 78.0 months in the P-SATr and N-SATr groups (P < 0.01). Multivariate analysis revealed P-SATr [hazard ratio (HR) = 1.95; 95% confidence interval (CI): 1.02-3.75; P = 0.04], serum carbohydrate antigen 19-9 level > 300 U/mL (HR = 3.68; 95% CI: 1.68-8.07; P < 0.01), presence of lymph node metastasis (HR = 2.04; 95% CI: 1.19-3.50; P < 0.01), and positive residual tumor status (HR = 4.61; 95% CI: 2.21-9.60; P < 0.01) as independent predictive factors for OS.
CONCLUSIONS: P-SATr during the preoperative waiting period was associated with poor prognosis in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.
METHODS: This study included patients with perihilar cholangiocarcinoma who underwent major hepatectomy and extrahepatic bile duct resection as curative treatment. SATr was evaluated using plain computed tomography images. The chronological changes in SATr were calculated as SATr at surgery minus SATr at diagnosis. SATr changes of > 0 or ≤ 0 Hounsfield units were defined as positive (P-SATr) or negative SATr changes (N-SATr), respectively. The primary outcome was postoperative OS according to the change in SATr. The prognostic factors for OS were also evaluated using a Cox proportional hazard model.
RESULTS: The study enrolled 104 patients, including 75 and 29 patients with P-SATr and N-SATr, respectively. P-SATr was associated with higher serum carcinoembryonic antigen levels and greater amount of adjusted blood loss during the operation. There were no significant differences in the in-hospital mortality and complication rates as well as postoperative hospital stay between the P-SATr and N-SATr groups. The median OS durations were 37.3 and 78.0 months in the P-SATr and N-SATr groups (P < 0.01). Multivariate analysis revealed P-SATr [hazard ratio (HR) = 1.95; 95% confidence interval (CI): 1.02-3.75; P = 0.04], serum carbohydrate antigen 19-9 level > 300 U/mL (HR = 3.68; 95% CI: 1.68-8.07; P < 0.01), presence of lymph node metastasis (HR = 2.04; 95% CI: 1.19-3.50; P < 0.01), and positive residual tumor status (HR = 4.61; 95% CI: 2.21-9.60; P < 0.01) as independent predictive factors for OS.
CONCLUSIONS: P-SATr during the preoperative waiting period was associated with poor prognosis in patients with perihilar cholangiocarcinoma undergoing major hepatectomy.