European Radiology: Bone Density Can Predict the Prognosis of Elderly Liver Cancer Patients Treated with TACE!

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and one of
the leading causes of cancer-related death worldwide.
Guidelines from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) both recommend the Barcelona Clinic Liver Cancer (BCLC) classification system as a framework
for stratification, treatment allocation, and prognosis prediction of HCC patients.
According to the BCLC classification, transarterial chemoembolization (TACE) is the treatment
of choice for patients with intermediate and advanced HCC.
Clinically, however, medium-term disease includes a heterogeneous group of patients with large differences
in tumor burden and remaining liver function.
Therefore, risk scores and prognosis predictions in patients treated with TACE are very difficult
.

Quantification of bone mineral density (BMD) is a new, valuable prognostic factor
for HCC patients.
Bone density is usually assessed using dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT).

However, these methods come at an additional cost and radiation exposure
.
Image data routinely obtained during diagnostic work can be used for rapid assessment
of BMD.
However, pre-treatment BMD measurement has not been used as a risk assessment factor
in TACE patients.

Recently, a study published in the journal European Radiology evaluated the value of osteoporosis in HCC patients undergoing TACE, providing technical support
for a more convenient and rapid clinical assessment of risk stratification in this type of patients.

This retrospective multicenter trial included 908 HCC patients
who did not respond to treatment who received TACE as first-line therapy in six tertiary care centers between 2010 and 2020.
BMD
is assessed by measuring the average housfeld (HUs) of the vertebral body core in the middle of the 11th thoracic vertebra in a contrast-enhanced computed tomography scan performed prior to treatment.
At the same time, the effect of BMD on median overall survival (OS) was evaluated, and multivariate analysis
was performed.

The median BMD was 145 HU (IQR, 115-175 HU).

Patients with high BMD (≥114 HU) had a median OS of 22.
2 months, while patients with low BMD (<114 HU) had a lower median OS of only 16.
2 months (P <.
001).

In addition to albumin, bilirubin, tumor number, and tumor diameter, BMD remains an independent prognostic factor
in multivariate analysis.

Based on Child-Pugh and ALBI scores, the distribution of bone mineral density (BMD) in different (A) Child-Pugh stages and (B) ALBI scoring stages was figured

This study shows that low BMD is an independent predictor of survival in elderly HCC patients receiving TACE
.
Incorporating BMD into novel scoring systems improves survival prediction and clinical decision-making
.

Original source:

Lukas Müller,Aline Mähringer-Kunz,Timo Alexander Auer,et al.
Low bone mineral density is a prognostic factor for elderly patients with HCC undergoing TACE: results from a multicenter study.
DOI:10.
1007/s00330-022-09069-8