Objective To investigate the predictive value of preoperative abdominal adipose tissue measurement for early recurrence after resection of hepatocellular carcinoma (HCC).

Methods The retrospective case-control study was conducted. The clinicopathological data of 238 patients with HCC who underwent surgical resection from January 2018 to January 2020 in 2 medical centers in China were collected, including 46 cases in the First Affiliated Hospital of Chongqing Medical University and 192 cases in the First Affiliated Hospital of Army Medical University. There were 207 males and 31 females, aged 51(48,65)years. All patients underwent abdominal computed tomography (CT) and/or magnetic resonance imaging (MRI) before surgery. Observation indicators: (1) measure-ment of abdominal adipose tissue; (2) follow-up; (3) analysis of influencing factors for early recurrence after resection of HCC; (4) prediction of early recurrence after resection of HCC. Follow-up was conducted by outpatient examinations and telephone interview to detect the postoperative survival of patients up to February 2022. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was performed by the t test. Measurement data with skewed distribution was represented by M(range) or M(Q₁,Q₃), and comparison between groups was performed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percen-tages, and the chi-square test was used for comparison between groups. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was performed using the Logistic regression model advance method. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the efficacy.

Results (1) Measure-ment of abdominal adipose tissue. Of the 238 patients, the total abdominal adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index, subcutaneous adipose tissue index were 292(198,355)cm², 153(99,194)cm², 128(95,154)cm², 106(76,130)cm²/m², (57±27)cm²/m², 46(34,58)cm²/m² for 139 patients with early postoperative recur-rence, versus 174(114,251)cm², 78(50,110)cm², 88(55,127)cm², 64(42,91)cm²/m², (30±16)cm²/m², 31(19,46) cm²/m² for 99 patients without early recurrence, respectively, showing significant diffe-rences between them (Z=‒7.39, ‒7.87, ‒5.03, ‒7.25, t=‒9.46, Z=‒5.00, P<0.05). (2) Follow-up. All the 238 patients were followed up according to the plan. The survival time of 238 patients was 26(8,44)months. The survival time was 11(5,18)months for patients with postoperative early recur-rence, versus 36(32,43)months for patients without early recurrence, respectively. (3) Analysis of influencing factors for early recurrence after resection of HCC. Results of univariate analysis showed that body mass index, total adipose tissue, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue index, visceral adipose tissue index and subcutaneous adipose tissue index were related factors for early recurrence after resection of HCC (t=‒5.88, Z=‒7.39, ‒7.87, ‒5.03, ‒7.25, t=‒9.46, Z=‒5.00, P<0.05). Results of multivariate analysis showed that visceral adipose tissue index was an independent influencing factor for early recurrence after resection of HCC (odds ratio=1.06, 95% confidence interval as 1.04‒1.08, P<0.05). (4) Prediction of early recurrence after resection of HCC. According to the results of multivariate analysis, the receiver operating characteris-tic curve showed that the area under curve of visceral adipose tissue index was 0.80 (95% confidence interval as 0.75‒0.86, P<0.05), with the sensitivity and specificity as 75.5% and 71.7%.

Conclusions Visceral adipose tissue index is an independent influencing factor for early recurrence after resection of HCC. The risk of early recurrence increases with the increase of visceral adipose tissue index.