Beneficial body mass index to enhance survival outcomes in patients with early-stage hepatocellular carcinoma following microwave ablation treatment

Figures & data

Figure 1. Flow diagram of patient selection in this study. HCC: hepatocellular carcinoma; PEI: percutaneous ethanol injection; TACE: transcatheter arterial chemoembolization.

Table 1. Characteristics of included patients and univariate analysis of survival outcomes.

Characteristic	Statistics	OS	DFS
	Mean ± SD/No. (%)	HR (95%CI) p Value	HR (95%CI) p Value
Age	57.6 ± 10.7	1.02 (0.99, 1.04) 0.09	1.00 (0.99, 1.02) 0.55
Gender
Female	107 (22.6%)	1.0	1.0
Male	367 (77.4%)	0.96 (0.59, 1.55) 0.86	1.46 (1.03, 2.09) 0.04
Size	2.6 ± 0.9	1.24 (0.99, 1.54) 0.06	1.03 (0.89, 1.18) 0.73
BMI grade
≤18.5	12 (2.5%)	1.0	1.0
≤22.9	131 (27.6%)	0.20 (0.07, 0.54) 0.00	0.68 (0.29, 1.57) 0.36
≤24.9	98 (20.7%)	0.27 (0.10, 0.73) 0.01	0.62 (0.26, 1.46) 0.27
≤29.9	202 (42.6%)	0.32 (0.13, 0.82) 0.02	0.77 (0.34, 1.77) 0.55
≥30	31 (6.5%)	0.62 (0.21, 1.88) 0.40	0.64 (0.24, 1.74) 0.38
Charlson Score
<3	287 (60.6%)	1.0	1.0
<6	164 (34.6%)	1.08 (0.70, 1.66) 0.74	1.18 (0.89, 1.56) 0.26
<9	19 (4.0%)	2.03 (0.88, 4.73) 0.10	0.97 (0.45, 2.08) 0.94
≥9	4 (0.8%)	–	1.91 (0.47, 7.75) 0.36
Tumor location
Dangerous location	235 (50.4%)	1.0	1.0
Safe location	239 (49.6%)	1.18 (0.79, 1.76) 0.43	1.19 (0.91, 1.56) 0.20
Cirrhosis
No	36 (7.6%)	1.0	1.0
HBV	375 (79.1%)	0.68 (0.35, 1.33) 0.26	0.98 (0.58, 1.66) 0.94
HCV	55 (11.6%)	1.23 (0.57, 2.64) 0.60	1.15 (0.62, 2.15) 0.66
others	8 (1.7%)	0.57 (0.10, 4.93) 0.79	1.15 (0.44, 3.92) 0.39
Child
A	453 (95.8%)	1.0	1.0
B	20 (4.2%)	1.51 (0.70, 3.27) 0.30	1.51 (0.70, 3.27) 0.29
ALT
≤44	361 (76.2%)	1.0	1.0
>44	113 (23.8%)	1.33 (0.87, 2.02) 0.18	1.39 (0.76, 2.54) 0.31
Platelet
≤150	350 (73.8%)	1.0	1.0
>150	124 (26.2%)	1.18 (0.74, 1.89) 0.48	0.68 (0.49, 0.96) 0.03
NLR
≤2	339 (71.5%)	1.0	1.0
≤8	135 (28.5%)	1.72 (1.12, 2.66 )0.01	1.17 (0.87, 1.57) 0.31
ALBI
≤ −2.6	246 (51.9%)	1.0	1.0
≤0	228 (48.1%)	1.61 (1.07, 2.41) 0.02	1.15 (0.88, 1.51) 0.30
MELD
≤8	199 (42.0%)	1.0	1.0
≤10	206 (43.5%)	0.76 (0.48, 1.19) 0.22	0.80 (0.59, 1.07) 0.13
≤20	69 (14.6%)	0.63 (0.30, 1.32) 0.22	0.95 (0.63, 1.42) 0.79

Figure 2. Quintiles of BMI and rates of death events (A) and disease-progression events (B).

Table 2. Adjusted effects of BMI on survival results in multiple models.

Quintliles of BMI	Model 1		Model 2		Model3
	OS DFS		OS DFS		OS DFS
≤18.5	4.9 (1.8, 13.2) 0.0	1.4 (0.6, 3.2) 0.5	5.1 (1.9,14.1) 0.0	1.3 (0.5, 3.0) 0.6	5.2 (1.8,15.2) 0.0	1.4 (0.6, 3.4) 0.4
≤22.9	1.0	1.0	1.0	1.0	1.0	1.0
≤24.9	1.4 (0.8, 2.7) 0.3	0.9 (0.6, 1.3) 0.5	1.4 (0.7, 2.7) 0.3	0.9 (0.6, 1.3) 0.4	1.1 (0.6, 2.3) 0.7	0.8 (0.5, 1.2) 0.2
≤29.9	1.8 (1.0, 3.0) 0.0	1.1 (0.8, 1.6) 0.5	1.8 (1.1, 3.1) 0.0	1.1 (0.8, 1.6) 0.4	1.9 (1.1, 3.4) 0.0	1.1 (0.8, 1.6) 0.4
≥30	3.4 (1.5, 7.5) 0.0	1.0 (0.5, 1.8) 0.9	2.9 (1.3,6.7) 0.0	0.9 (0.5, 1.7) 0.7	2.7 (1.1, 6.6) 0.0	1.0 (0.5, 1.9) 0.9

Data were presented as HR (95%CI) p value.

Model 1 was adjusted for age, gender.

Model 2 was adjusted for age, size, Charlson Score.

Model 3 was adjusted for age, gender, size, Charlson Score, ALT, tumor location, NLR, platelet, MELD, Child-Pugh, ALBI, cirrhosis.

Figure 3. The relationship between BMI levels and survival outcomes. (A) BMI and overall survival*; (B) BMI and disease-free survival^#. *: adjusted for age, size, Charlson Score. #: adjusted for age, gender, size, Charlson Score, ALT, tumor location, NLR, platelet, MELD, Child-pugh, ALBI, cirrhosis.

Table 3. Threshold effect analysis of BMI on overall survival by piece-wise linear regression.

BMI	Crude HR	LLR test	Adjusted HR	LLR test
	(95%CI) p Value		(95%CI) p Value
OS		0.01		0.00
<21.5	0.76 (0.61, 0.94) 0.01		0.72 (0.57, 0.90) 0.00
21.5–23.1	0.71 (0.26, 1.98) 0.52		0.79 (0.28, 2.28) 0.67
>23.1	1.14 (1.03, 1.25) 0.01		1.13 (1.02, 1.24) 0.01
DFS		0.28		0.10
<21.5	0.92 (0.75, 1.12) 0.53		0.90 (0.73, 1.10) 0.53
21.5–23.1	0.73 (0.42, 1.28) 0.16		0.64 (0.35, 1.14) 0.16
>23.1	1.01 (0.94, 1.08) 0.84		1.02 (0.95, 1.10) 0.84

Adjusted model for OS was adjusted for age, size, and Charlson score; Adjusted model for DFS was adjusted for age, gender, size, Charlson Score, ALT, tumor location, NLR, platelet, MELD, Child-Pugh, ALBI, cirrhosis.

Figure 4. Comparison of OS (A) and DFS (B) in patients with BMI between turning points and BMI overflowed turning points.