colorectal cancer, liver metastasis, neoadjuvant chemotherapy, visceral adipose tissue, visceral obesity, Diseases of the musculoskeletal system, RC925-935, Human anatomy, QM1-695

ABSTRACT Background Visceral obesity (VO), associated with excessive visceral adipose tissue (VAT), has been extensively studied in cancer. However, whether low VAT can predict the prognosis of colorectal liver metastases (CRLM) undergoing neoadjuvant chemotherapy (NAC) remains unknown. Methods This multicentre real‐world cohort study analysed data from initially resectable CRLM patients who received NAC. The predictive effect of VAT on progression‐free survival (PFS) and overall survival (OS) was evaluated using restricted cubic splines (RCS). VAT was categorized into low/normal VAT and VO groups using X‐tile. The prognostic differences were further assessed through Kaplan–Meier (KM) analysis. The impact of changes in VAT (ΔVAT) after NAC was evaluated. Results Among 1524 CRLM patients, 1105 patients (72.51%) were under 65 years old, with a median VAT of 84.00 (36.24–148.00) cm2. Of all patients, 804 (52.76%) were female. A U‐shaped nonlinear relationship was observed between VAT and both PFS/OS (p