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Association of computed tomography-based body composition with survival in metastatic renal cancer patient received immunotherapy: a multicenter, retrospective study

  • Computed Tomography
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the association of computed tomography-assessed body composition with survival outcomes of metastatic renal cell carcinoma (mRCC) received immunotherapy.

Methods

In this multicenter, retrospective study, we reviewed 251 mRCC patients who received anti-PD1 from five centers. We analyzed the relationship between BMI, skeletal muscle area (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and subcutaneous adipose percentage (SAT%) with progression-free survival (PFS) and overall survival (OS). The spatial localization T cells was investigated by multiplex immunofluorescence.

Results

Among 224 evaluable patients, 23 (10.3%) patients were underweight, 118 (52.7%) had normal weight, 65 (29%) were overweight, and 18 patients (8%) were obese. The median age was 55 years and most patients were male (71%). No significant improvement in PFS (HR, 0.61; 95% CI, 0.27–1.42) or OS (HR, 1.09; 95% CI, 0.38–3.13) was observed for the obese patients. Besides, SM, VAT, and SAT were not associated with survival outcomes (all p > 0.05). Interestingly, SAT% independently predicted PFS (as continuous variable, HR: 0.02; 95% CI, 0.01–0.11) and OS (HR:0.05; 95% CI, 0.01–0.39), which remained significant in multivariate modeling (as continuous variable, adjusted HR for PFS, 0.01; 95% CI, 0.00–0.04; adjusted HR for OS, 0.08; 95% CI, 0.01–0.72). These associations were consistent in subgroup analysis of different gender, BMI, PD-L1 positive, and sarcopenia group. Tumor of high SAT% patients had a higher intratumoral PD1+ CD8+ T cell density and ratio.

Conclusion

High SAT% predicts better outcomes in mRCC patients treated with anti-PD1 and T cell location may account for the better response.

Key Points

• CT-based subcutaneous adipose percentage independently predicted progression-free survival and overall survival.

• Patients with a higher subcutaneous adipose percentage had a higher intratumoral PD1 + CD8 + T cell density and ratio.

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Abbreviations

BMI:

Body mass index

FFPE:

Formalin-fixed paraffin-embedding

HFD:

High-fat diet

ICIs:

Immune checkpoint inhibitors

IRB:

Institutional review board

mIHC:

Immunofluorescence

mRCC:

Metastatic renal cell carcinoma

OS:

Overall survival

PFS:

Progression-free

SAT%:

Subcutaneous adipose percentage

SAT:

Subcutaneous adipose tissue

SM:

Skeletal muscle area

TKI:

Tyrosine kinase inhibitor

TME:

Tumor microenvironment

VAT:

Visceral adipose tissue

WHO:

World Health Organization

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Acknowledgements

We thank all the patients who participated in this study.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82203288, 82203320, 81972382, 82273031, 82273311, and 81872091), Medical Scientific Research Foundation of GuangDong Province (A2022492), China National Postdoctoral Program for Innovative Talents (No. BX20220363), and the Natural Science Foundation for Distinguished Young Scholars of Guangdong Province (No. 2021B1515020077).

Author information

Author notes

  1. Jun Wang, Pei Dong, Yuanyuan Qu, Wenhao Xu and Zhaohui Zhou contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China

    Jun Wang, Pei Dong, Zhaohui Zhou, Kang Ning, Yulu Peng, Longbin ** Yu & Zhiling Zhang

  2. Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China

    Jun Wang, Pei Dong, Zhaohui Zhou, Kang Ning, Yulu Peng, Longbin ** Yu & Zhiling Zhang

  3. Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China

    Yuanyuan Qu, Wenhao Xu, ** Yu

Authors
  1. Jun Wang
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  2. Pei Dong
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  23. Zhiling Zhang
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Corresponding authors

Correspondence to Dingwei Ye, Chun** Yu or Zhiling Zhang.

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Guarantor

The scientific guarantor of this publication is Zhiling Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

The written patient informed consent was obtained from each participating center and for some cases waiver of consent was been approved by the IRB at the corresponding center.

Ethical approval

This study has been approved by the institutional review board (IRB) and the ethical committee of Sun Yat-sen University Cancer Center and was conducted in accordance with ethical principles for medical research involving human subjects reported in the Declaration of Helsinki and its later amendments.

Methodology

• Retrospective

• observational

• multicenter study

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Wang, J., Dong, P., Qu, Y. et al. Association of computed tomography-based body composition with survival in metastatic renal cancer patient received immunotherapy: a multicenter, retrospective study. Eur Radiol 33, 3232–3242 (2023). https://doi.org/10.1007/s00330-022-09345-7

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  • DOI: https://doi.org/10.1007/s00330-022-09345-7

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