Body composition alterations are highly prevalent in cholangiocarcinoma (CCA) and may be associated with lower disease free survival (DFS) and overall survival (OS), according to a study recently published in Hepatology Communications.

Although unintentional weight loss is a classical feature of CCA, obesity tends to mask wasting signs in many CCA patients. However, assessment of computed tomography (CT) images with a segmentation tool at the level of the third lumbar vertebrae can measure metrics such as the lumbar skeletal muscle index, skeletal muscle radiation attenuation, and visceral fat area.

“The worldwide obesity epidemic has led to an increasing proportion of patients with masked wasting symptoms at presentation,” the authors of the study wrote. “In this regard, expanding the analysis of body composition beyond classical metrics, like body mass index (BMI), has the potential to reveal wasting and alterations of lean tissues and is of prognostic value in oncological disease and liver disease.”

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The authors aimed to study the prevalence and prognostic value of body composition pathologies such as sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity using CT images from patients undergoing curative-intent surgery for CCA between 2010 and 2019 in the University Hospital Aachaen in Germany. Due to the difference in both prognosis and etiology, patients with intrahepatic (iCCA) and perihiliar (pCCA) diseases were analyzed separately.

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Body composition alterations were present in most patients. Overweight and obesity were found in 50% of patients, sarcopenia in 34%, and myosteatosis in 66%. The authors did not find a significant difference in the incidence of body composition alterations between patients with iCCA and pCCA. 

Patients with iCCA and sarcopenic obesity had an OS of 11 months, compared with a median of 31 months among patients without sarcopenic obesity; 1-year mortality was 55.6%, compared with 22% in patients without sarcopenic obesity. On the other hand, in patients with pCCA, body composition alterations were not associated with shorter OS or DFS. However, patients with a BMI of at least 25 kg/m2 had a higher incidence of postoperative complications.

“Approximately one half of our study population was overweight or obese at the time of operation, making it unlikely that these patients would routinely attract clinical attention as being malnourished,” the study team wrote. “Thus, raising the attention to muscle wasting that is masked by excessive adipose tissue may allow for prognostic patient selection and risk stratification as well as facilitate therapeutic interventions, such as nutritional counseling and support and physical prehabilitation.”


Lurje I, Czigany Z, Eischet S, et al. The prognostic impact of preoperative body composition in perihilar and intrahepatic cholangiocarcinoma. Hepatol Commun. Published online May 26, 2022. doi:10.1002/hep4.2004