Improved risk stratification in patients with colorectal liver metastases by incorporating volumetric body composition analysis.

Skeletal muscle and subcutaneous adipose tissue were identified as significant independent indicators for overall survival in colorectal liver metastases patients.

• Skeletal muscle (SKM) had a hazard ratio of 0.63 (95% CI: 0.42-0.94) for overall survival
• Subcutaneous adipose tissue (SAT) had a hazard ratio of 0.59 (95% CI: 0.37-0.92) for overall survival
• Both metrics were derived from volumetric AI-powered automated measurement on preoperative CT images spanning L1-L4
• Study included 186 patients with colorectal liver metastases who underwent hepatectomy

A rule-based Body Composition Signature (BCS) was developed using SKM and SAT to classify patients into three risk groups.

• Low SKM and low SAT defined the high-risk group
• High SKM and high SAT defined the low-risk group
• All other combinations were classified as medium risk
• The BCS was derived from preoperative CT-based volumetric body composition analysis

The Body Composition Signature alone demonstrated significant differences in survival outcomes across its three risk subgroups.

• Significant differences were observed among the three BCS subgroups for overall survival, disease-free survival, and hepatic-specific disease-free survival
• All comparisons yielded log-rank p < 0.05
• Kaplan-Meier plots were used to depict survival differences across risk groups

Composite scoring systems combining BCS with CRS or TBS improved patient risk stratification over standalone traditional scoring systems.

• Both CRS-BCS and TBS-BCS composite systems showed significant improvement in risk stratification for all three survival outcomes (OS, DFS, and hepatic DFS)
• All log-rank p values for the composite systems were < 0.05
• The composite systems demonstrated higher time-dependent AUC than their standalone counterparts for OS, DFS, and hepatic DFS

AI-powered automated volumetric body composition analysis was applied to preoperative CT images to measure four body composition components.

• Measurements were conducted across the L1-L4 vertebral levels on preoperative CT images
• Four components were measured: skeletal muscle (SKM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT)
• The study was retrospective, including 186 patients with colorectal liver metastases