TotalSegmentator-derived body composition from CT predicts survival in immunotherapy-treated cancers

Automated CT body composition via TotalSegmentator predicted overall survival in 357 cancer patients on immunotherapy. Volumetric muscle-to-bone ratio had c-index 0.616; combining all tissue density and quantity reached 0.621. Five-year mortality was 84% (95% CI 80-88%).

• L3 and whole-body CT volume parameters were strongly correlated (r=0.87–0.98), supporting volumetric over single-slice measurement.
• Area-based IMAT and VAT indices at L3 and T4 were not discriminative (p=0.068 and p=0.169), while all volume-based markers differed significantly between survival groups.
• Integrating density and quantity biomarkers of all tissues yielded the highest c-index (0.621) for overall survival.

Automated summary

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