The value of sex-specific abdominal visceral fat as measured via CT as a predictor of clear renal cell carcinoma T stage

Development of a CT-assessed adiposity nomogram for predicting outcome in localized ccRCC

PURPOSE

This study aimed to develop and validate a computed tomography-based nomogram assessing visceral and subcutaneous adiposity for predicting outcomes in localized clear cell renal cell carcinoma (ccRCC).

METHODS

A cohort of 364 patients with pathologically confirmed ccRCC participated in this retrospective study, with 254 patients assigned to the training set and 110 to the validation set (a 7:3 distribution ratio). The adipose score (AS) was generated using the least absolute shrinkage and selection operator Cox regression. Subsequently, a nomogram was constructed by integrating the clinical independent predictor with the AS to predict disease-free survival (DFS) in localized ccRCC after surgery. The performance of the nomogram was compared with the University of California, Los Angeles, Integrated Staging System (UISS), and the Stage, Size, Grade, and Necrosis (SSIGN) score.

RESULTS

In both the training and validation cohorts, the nomogram exhibited superior discrimination compared to SSIGN and UISS (C-index: 0.897 vs. 0.781 vs. 0.776 in the training cohort, and 0.752 vs. 0.596 vs. 0.686 in the validation cohort; 5 year AUC: 0.907 vs. 0.805 vs. 0.820 in the training cohort, and 0.832 vs. 0.577 vs. 0.726 in the validation cohort). Decision curve analysis (DCA) revealed a superior net benefit across a wider range of threshold probabilities for predicting 5 year DFS compared to UISS and SSIGN scores.

CONCLUSIONS

The developed prognostic nomogram demonstrated high accuracy and overall superior performance compared to existing prognostic models.

Association between CT-based adipose variables, preoperative blood biochemical indicators and pathological T stage of clear cell renal cell carcinoma

Background

Clear cell renal cell carcinoma (ccRCC) is corelated with tumor-associated material (TAM), coagulation system and adipocyte tissue, but the relationships between them have been inconsistent. Our study aimed to explore the cut-off intervals of variables that are non-linearly related to ccRCC pathological T stage for providing clues to understand these discrepancies, and to effectively preoperative risk stratification.

Methods

This retrospective analysis included 218 ccRCC patients with a clear pathological T stage between January 1st, 2014, and November 30th, 2021. The patients were categorized into two cohorts based on their pathological T stage: low T stage (T1 and T2) and high T stage (T3 and T4). Abdominal and perirenal fat variables were measured based on preoperative CT images. Blood biochemical indexes from the last time before surgery were also collected. The generalized sum model was used to identify cut-off intervals for nonlinear variables.

Results

In specific intervals, fibrinogen levels (FIB) (2.63-4.06 g/L) and platelet (PLT) counts (>200.34 × 109/L) were significantly positively correlated with T stage, while PLT counts (<200.34 × 109/L) were significantly negatively correlated with T stage. Additionally, tumor-associated material exhibited varying degrees of positive correlation with T stage at different cut-off intervals (cut-off value: 90.556 U/mL).

Conclusion

Preoperative PLT, FIB and TAM are nonlinearly related to pathological T stage. This study is the first to provide specific cut-off intervals for preoperative variables that are nonlinearly related to ccRCC T stage. These intervals can aid in the risk stratification of ccRCC patients before surgery, allowing for developing a more personalized treatment planning.

Sex differences in abdominal visceral fat composition and metabolism as predictors of DLBCL prognosis: A retrospective cohort study

PURPOSE

We aimed to determine if sex differences in abdominal visceral fat composition and metabolism can help predict the prognosis of diffuse large B-cell lymphoma (DLBCL) patients.

METHODS

This retrospective cohort study included 117 DLBCL patients. The area and metabolic activity of subcutaneous adipose tissue and visceral adipose tissue were measured using CT and PET imaging. Kaplan-Meier survival analysis was employed to evaluate the effect of these parameters on progression-free survival. Multivariate Cox proportional hazard regression models were used to determine the effects of relative visceral fat area (rVFA) on sex-specific survival.

RESULTS

Females with an rVFA greater than the optimal threshold of 35 % and a visceral-to-subcutaneous adipose tissue ratio (V/S) >3.24 had worse progression-free survival (p = 0.01, 0.001, respectively). No rVFA or V/S were identified in significantly stratified males with DLBCL (p = 0.249 and 0.895, respectively). Combining the changes in rVFA and V/S identified a subgroup of females with high rVFA and V/S values and exceptionally poor outcomes. The rVFA was a significant predictor of DLBCL progression in females alone.

CONCLUSION

Once female DLBCL patients accumulate fat over the tolerable range in the visceral area, they might be at an increased risk of progression (hazard ratio, 3.87; 95 % CI, 1.81-12.69, p = 0.02). Sex differences in visceral fat composition and metabolism may provide a new risk stratification system for patients with DLBCL.

Evaluation of the relations between reproduction-related pituitary and ovarian hormones and abdominal fat area-related variables determined with computed tomography in overweight or obese women who have undergone bariatric surgery: a cross-sectional study

Background

An understanding of the associations between midregion fat depots and systemic hormone levels will be crucial for developing health-promotion messages aimed at overweight or obese women. However, related research in this area is rare. The present study was performed to identify and quantify fat-related reproduction pituitary and ovarian hormones in overweight or obese women.

Methods

A total of 250 eligible overweight or obese women scheduled to undergo laparoscopic sleeve gastrectomy (LSG) from a single center were retrospectively included in this study. Computed tomography (CT) images at the level of the umbilicus were selected, and abdominal fat areas were measured and calculated. The reproduction-related pituitary and ovarian hormones were also measured. The correlations among the parameters were examined using Spearman correlation test. Multiple linear regression analysis was performed after log and β-transformation of the hormone levels and fat area-related variables.

Results

Positive correlations were detected for prolactin (PRL) with total fat area (TFA) [β=0.045; P=0.029; 95% confidence interval (CI): 0.004-0.085] and subcutaneous fat area (SFA) (β=0.066; P=0.023; 95% CI: 0.009-0.123), whereas estradiol showed a negative correlation with visceral fat area (VFA) (β=-0.056, P=0.005; 95% CI: -0.096 to -0.017) and relative VFA (rVFA) (β=-0.068; P=0.001; 95% CI: -0.109 to -0.027) and a positive correlation with SFA (β=0.036; P=0.042; 95% CI: 0.001-0.071). Progesterone (PROG) was negatively correlated with both VFA (β=-0.037; P=0.002; 95% CI: -0.061 to -0.013) and rVFA (β=-0.039; P=0.002; 95% CI: -0.063 to -0.014). The final results revealed that TFA was increased by 3.1% and SFA was increased by 4.7% with a doubling of PRL concentration; VFA was reduced by 2.5% and rVFA was reduced by 2.6% with a doubling of PROG concentration; and VFA was reduced by 3.8%, rVFA was reduced by 4.6%, and SFA was increased by 2.5% with a doubling of estradiol concentration.

Conclusions

There exist certain associations between some reproduction-related pituitary and ovarian hormones and fat areas. Our findings provide new insights into the associations between midregion fat depots and systemic hormone levels in overweight or obese women.

Cohort profile - the Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study in the Netherlands

PURPOSE

The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life.

PARTICIPANTS

The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I-III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry.

FINDINGS TO DATE

A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised.

FUTURE PLANS

Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.

Association of visceral and subcutaneous adiposity with tumor stage and Fuhrman grade in renal cell carcinoma

Higher BMI has been associated with lower tumor stage and grade and improved survival in renal cell cancer (RCC). BMI cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We examined associations of BMI, VAT, SAT, total adipose tissue (TAT) and relative VAT (rVAT) with tumor stage and grade in RCC patients. In a Dutch multicenter population-based historical cohort study 1039 RCC patients diagnosed between 2008 and 2012 were assessed for VAT and SAT using Computed Tomography images at L3. Sex-stratified multinomial logistic regression analyses were performed (linearly per 10-unit increase) between BMI, VAT, SAT, TAT and relative VAT (rVAT) with tumor stage and Fuhrman grade. Higher VAT, TAT and rVAT were associated with a lower risk of stage IV versus stage I in males (OR 0.93; 95%CI 0.91–0.96, OR 0.95; 95%CI 0.93–0.98, OR 0.97; 95%CI 0.96–0.99, respectively). Females showed similar associations, but only higher VAT was statistically significantly associated with reduced risk of stage IV (OR 0.95 95%CI 0.89–1.00). No associations with grade, SAT or BMI were found. In conclusion, higher VAT and TAT was associated with lower risk of stage IV RCC. This might be due to weight loss or cancer cachexia in stage IV patients.