Association Between Visceral Fat Area and Cancer Prognosis: A Population-Based Multicenter Prospective Study

MDiverse indicators have been used to represent adipose tissue, while the relationship between body adipose mass and the prognosis of patients with cancer remains controversial. In this study, we aimed to explore the indicators of optimal body composition that represent body fat mass to predict the risk of cancer-related mortality. We conducted a population-based multicenter prospective cohort study of patients with initial cancer between February 2012 and September 2020. Clinical information, body composition indicators, hematologic test results, and follow-up data were collected. Body composition indicators were analyzed using principal component analysis to select the most representative indicators, and the cutoff value was set according to the optimal stratification method. The hazard ratio (HR) for mortality was calculated using Cox proportional hazards regression models. Among 14, 018 patients with complete body composition data, visceral fat area (VFA) is a more optimal indicator for body fat content (principal component index, PCI:0.961) than body mass index (PCI: 0.850). The cutoff points for VFA in terms of time to mortality were 66 cm2 and 102 cm2 for gastric/esophageal cancer and other cancers, respectively. Among the 2788 patients treated systemically, multivariate analyses demonstrated that a lower VFA was associated with a higher risk of death in patients with cancer of diverse types (HR: 1.33, 95% confidence interval [CI]:1.08–1.64, P=0.007), especially gastric cancer (HR: 2.13, 95% CI: 1.3–3.49, P=0.003), colorectal cancer HR: 1.81, 95% CI: 1.06–3.08, P=0.030) and non-small cell lung cancer (HR: 1.27, 95% CI: 1.01–1.59, P=0.040). VFA is an independent prognostic indicator of muscle mass in patients with diverse types of cancer, particularly gastric, colorectal, and non-small cell lung cancers.