Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma

Abstract

This study aimed to investigate the impact of sarcopenia and body composition on survival outcomes in Korean patients with advanced-stage high-grade serous ovarian carcinoma (HGSOC). We retrospectively identified patients diagnosed with and treated for International Federation of Gynecology and Obstetrics stage III-IV HGSOC. Skeletal muscle index (SMI) was measured using pre-treatment computed tomography scans at the third lumbar vertebra. Sarcopenia was defined as SMI <39.0 cm2/m2. Patients’ clinicopathologic characteristics and survival outcomes were compared according to sarcopenia presence. For subgroup analysis, we also measured the total fat area from the same image. In total, 76 and 103 patients were assigned to the sarcopenia and control groups, respectively. Comorbidities, stage, serum CA-125 levels, and size of residual tumor after surgery were similar between both groups. After a median follow up of 42.7 months, both groups showed similar progression-free survival (PFS) and overall survival (OS). In subgroup analysis confined to the sarcopenia group, patients with high fat-to-muscle ratio (FMR; ≥2.1, n = 38) showed significantly worse OS than those with low FMR (<2.1, n = 38) (5-year survival rate, 44.7% vs. 80.0%; p = 0.046), whereas PFS was not different (p = 0.365). Multivariate analyses identified high FMR as an independent poor prognostic factor for OS in this group (adjusted hazard ratio, 3.377; 95% confidence interval, 1.170–9.752; p = 0.024). In conclusion, sarcopenia did not influence recurrence rates and survival in Korean patients with advanced-stage HGSOC. However, among the patients with sarcopenia, high FMR was associated with decreased OS.

The Prognostic Relevance of Computed Tomography-assessed Skeletal Muscle Index and Skeletal Muscle Radiation Attenuation in Patients With Gynecological Cancer

“…Baseline low SMI and low SMRA have been detected in 11%-64% and 21.1%-35% of patients with advanced ovarian cancer, respectively (Table VI) (16,26,(39)(40)(41)(42)(43)(44)(45)(46)(47). The prognostic relevance of SMI and SMRA is reported in Table VII.…”

“…With the introduction of methods of in vivo body composition evaluation such as magnetic resonance imaging (MRI) and computed tomography (CT), the measurement of skeletal muscle mass with cross-sectional imaging has become a very common tool of sarcopenia assessment, although there is a wide heterogeneity in both the parameters taken into consideration and the diagnostic criteria used by different authors (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The assessment of psoas muscle area-only is easy and quick, but it is not representative of the total body skeletal muscle (19).…”

“…Among 55 women with metastatic breast cancer resistant to anthracycline and/or taxane, Prado et al (6) reported capecitabine-related toxicity in 50% of sarcopenic versus 20% of non-sarcopenic patients (p=0.03). The impact of sarcopenia in patients with malignancies of the female genital tract has yet to be clearly elucidated (12,16,17,19,23,26,28).…”

“…A Korean study assessed patients who underwent primary debulking surgery or interval debulking surgery and platinum/taxane-based chemotherapy (16). Baseline SMI itself did not correlate with the clinical outcome.…”

Rethinking Radical Surgery in Interval Debulking Surgery for Advanced-Stage Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy

“…Second, NAC has been used as an alternative treatment in our institution since late 2010; thus, our cohort was limited by a short period of follow-up. Third, analysis of various factors, such as sarcopenia or body composition, which can affect survival outcomes in patients undergoing NAC is needed [25,26].…”