Predicting cachexia in hepatocellular carcinoma patients: a nomogram based on MRI features and body composition

Background Approximately half of all patients with hepatocellular carcinoma (HCC) develop cachexia during the course of the disease. It is important to be able to predict which patients will develop cachexia at an early stage. Purpose To develop and validate a nomogram based on the magnetic resonance imaging (MRI) features of HCC and body composition for potentially predicting cachexia in patients with HCC. Material and Methods A retrospective two-center study recruited the pretreatment clinical and MRI data of 411 patients with HCC undergoing abdominal MRI. The data were divided into three cohorts for development, internal validation, and external validation. Patients were followed up for six months after the MRI scan to record each patient's weight to diagnose cachexia. Logistic regression analyses were performed to identify independent variables associated with cachexia in the development cohort used to build the nomogram. Results The multivariable analysis suggested that the MRI parameters of tumor size > 5 cm ( P = 0.001), intratumoral artery ( P = 0.004), skeletal muscle index ( P < 0.001), and subcutaneous fat area ( P = 0.004) were independent predictors of cachexia in patients with HCC. The nomogram derived from these parameters in predicting cachexia reached an area under receiver operating characteristic curve of 0.819, 0.783, and 0.814 in the development, and internal and external validation cohorts, respectively. Conclusion The proposed multivariable nomogram suggested good performance in predicting the risk of cachexia in HCC patients.