Osteopenic occult vertebral fracture is associated with poor oncological outcome in patients with hepatocellular carcinoma after hepatic resection

Abstract

Background

Although osteopenia has been associated with poor outcomes in patients with hepatocellular carcinoma (HCC), the oncological impact of occult vertebral fracture (OVF) has not been investigated.

Methods

The study comprised 235 patients who had undergone primary hepatic resection for hepatocellular carcinoma between 2008 and 2019. Osteopenia was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. OVF was defined if the ratios of central/anterior or central/posterior heights of the vertebrae, measured using sagittal computed tomography reconstruction between 11th thoracic vertebra to 5th lumber vertebrae, <0.8. Multivariate Cox proportional hazard models were conducted to assess disease-free and overall survival adjusting for potential confounders.

Results

Occult vertebral fracture was identified in 93 patients (40%), while osteopenia in 65 patients (28%). Osteopenic OVF was identified in 27 patients (12%). In multivariate analysis, gender (p < 0.001), serum PIVKA-II level ≥ 200 mAU/ml (p = 0.005), C-reactive protein-to-albumin ratio ≥0.04 (p = 0.03), multiple tumors (p < 0.001), type of resection (p < 0.001), low skeletal muscle index (p = 0.002), and osteopenic OVF (HR 3.07, 95% CI 1.78–5.28, p < 0.001) were independent and significant predictors of cancer recurrence, while gender (p = 0.002), Child–Pugh grade B (p = 0.009), C-reactive protein-to-albumin ratio ≥0.04 (p = 0.03), multiple tumors (p = 0.005), low skeletal muscle index (p < 0.001), and osteopenic OVF (HR 4.75, 95% CI 2.41–9.39, p < 0.001) were independent predictors of overall survival.

Conclusions

Osteopenic OVF is associated with poor oncological outcomes in patients with hepatocellular carcinoma after hepatic resection. Our findings provide a compelling rationale for the further investigation of the interplay between tumor and bone metabolism.