Skeletal muscle and visceral adipose radiodensities are pre‐surgical, non‐invasive markers of aggressive kidney cancer
Authors: Furberg Helena , Bradshaw Patrick T. , Knezevic Andrea , Olsson Linnea , Petruzella Stacey , Stein Emily , Paris Mike , Scott Jessica , Akin Oguz , Hakimi A. Ari , Russo Paul , Sanchez Alejandro , Caan Bette , Mourtzakis Marina 
Published: January 2024

Introduction

Most studies on body composition in kidney cancer have been conducted among patients with metastatic disease. Given that aggressive tumours can adversely impact body composition and even non‐metastatic tumours can be aggressive, we evaluated associations between pre‐surgical body composition features and tumour pathological features in patients with non‐metastatic clear cell renal cell cancer (ccRCC).

Methods

The Resolve Cohort consists of 1239 patients with non‐metastatic ccRCC who underwent nephrectomy at Memorial Sloan Kettering Cancer Center between 2000 and 2020. The cross‐sectional areas and radiodensities of skeletal muscle, visceral adipose, and subcutaneous adipose tissues were determined from pre‐surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. Pearson's correlation coefficients describe inter‐relationships among BMI and body composition variables, while odds ratios (OR) and 95% confidence intervals (CI) estimate associations between continuous body composition features (per 1‐standard deviation) and advanced stage (Stage III vs. Stages I–II) and high Fuhrman grade (Grades 3–4 vs. 1–2) from multivariable logistic regression models that considered the potential impact of biological sex, contrast enhanced CTs, and early age at onset of ccRCC.

Results

The cohort was predominantly male (69%), white (89%), and had a median age of 58. The proportion of patients presenting with advanced stage and high‐grade disease were 31% and 51%, respectively. In models that adjusted for demographics and all body composition variables simultaneously, decreasing skeletal muscle radiodensity (i.e., more fat infiltration) but increasing visceral adipose tissue radiodensity (i.e., more lipid depletion) were associated with advanced tumour features. Per 8.4 HU decrease in skeletal muscle radiodensity, the odds of presenting with advanced stage was 1.61 (95% CI: 1.34–1.93). Per 7.22 HU increase in visceral adipose tissue radiodensity, the odds of presenting with advanced stage was 1.45 (95% CI: 1.22–1.74). Skeletal muscle index (i.e., sarcopenia) was not associated with either tumour feature. Similar associations were observed for Fuhrman grade, a more direct marker of tumour aggressiveness. Associations did not differ by sex, contrast use, or age at onset of ccRCC.

Conclusions

Lipid infiltrated skeletal muscle, but lipid depleted visceral adipose tissue were independently associated with advanced tumour features in non‐metastatic ccRCC. Findings highlight the importance of evaluating the full range of body composition features simultaneously in multivariable models. Interpreting pre‐surgical CTs for body composition for patients may be a novel and non‐invasive way to identify patients with aggressive renal tumours, which is clinically relevant as renal biopsies are not routinely performed.