Skeletal Muscle Attenuation (Sarcopenia) Predicts Reduced Overall Survival in Patients with Advanced Epithelial Ovarian Cancer Undergoing Primary Debulking Surgery

Ataseven, Beyhan; Luengo, Teresa González; Bois, Andreas du; Waltering, K. U.; Traut, Alexander; Heitz, Florian; Alesina, Pier Francesco; Prader, Sonia; Meier, Beate; Schneider, Stephanie; Koch, Jens‐Albrecht; Walz, Martin K.; Groeben, Harald-Thomas; Pauly, N; Brunkhorst, Violeta; Heikaus, Sebastian; Harter, Philipp

doi:10.1245/s10434-018-6683-3

Cited by 64 publications

(74 citation statements)

References 41 publications

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“…The flow diagram is illustrated in Figure 1. Fifteen studies6–12 20–27 were included in this systematic review, of which six studies were included in the meta-analysis 6–12. (Online supplementary Table S2 lists all excluded studies9 18 28–33 and the reasons for exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…The sample size ranged from 7420 to 323 patients 12. Three studies were performed in Germany,7 12 27 three in The Netherlands,9–11 five in the USA,12 20 23 25 26 three in Japan,21 22 24 and one in Austria 10. Fourteen studies were retrospective and one was prospective 20.…”

Section: Resultsmentioning

confidence: 99%

“…All muscle mass indexes assessed in the studies are defined in online supplementary Table S3. Six studies6–10 12 accounting for 1226 patients were included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 reports patient characteristics and results of the included studies. In 6 of the 15 studies,6–8 10 12 26 patient age (median or mean) was >65 years. Ten of 15 studies reported a body mass index (median or mean) of 24.96 to 28.023 (kg/m 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Recently, body composition, assessed by phase angle, was shown to be an independent predictor of residual disease and perioperative complications at the time of cytoreduction in ovarian cancer 5. Several other studies using CT scan imaging determined the impact of muscle mass on clinical outcomes in ovarian cancer 6–12. Low skeletal muscle index, assessed by CT scan, has been identified as a risk factor for several clinical outcomes in solid tumors 13.…”

Section: Introductionmentioning

confidence: 99%

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Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Rinninella

Fagotti

Cintoni

et al. 2020

Int J Gynecol Cancer

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BackgroundMuscle mass plays a key role in predicting clinical outcomes in cancer. This systematic review and meta-analysis aimed to evaluate whether computed tomography (CT) scan indexes of muscle mass quantity and quality could be used as prognostic factors in ovarian cancer.MethodsThree electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search from inception to January 2020. The primary outcome was overall survival. Pooled analyses of hazard ratios (HRs) and 95% confidence intervals (CIs) were performed with Review Manager 5.3. Heterogeneity was assessed by measuring inconsistency (I2 based on the χ2 test). Secondary outcomes included progression free survival, disease free survival, postoperative complications, and chemotoxicity. Study quality and quality of evidence were assessed.ResultsA total of 15 studies were included in the systematic review, of which six studies (1226 patients) were included in the meta-analysis. Summary unadjusted HRs (HR 1.11, 95% CI 0.84 to 1.46, p=0.47) and adjusted HRs (HR 1.10, 95% CI 0.84 to 1.43, p=0.49) did not show a significant association between low skeletal muscle index and overall survival (p>0.05) in ovarian cancer. Instead, although the quality of evidence was low, pooled data of three studies, comprising 679 patients, showed a significant association between low skeletal muscle radiodensity and poor overall survival (HR 1.63, 95% CI 1.28 to 2.07, p<0.0001). Moreover, the heterogeneity between studies precluded the possibility of performing a meta-analysis and reaching conclusions for progression free survival, disease free survival, surgical complications, and chemotoxicity.ConclusionsThis work suggested that the measurement of skeletal muscle radiodensity by routine CT scan at diagnosis, with standardization of diagnostic criteria, could be a reliable tool to select at risk patients and to individualize effective nutritional strategies. However, prospective homogeneous studies with a larger number of patients are required to confirm these results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…All muscle mass indexes assessed in the studies are defined in online supplementary Table S3. Six studies6–10 12 accounting for 1226 patients were included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Rinninella

Fagotti

Cintoni

et al. 2020

Int J Gynecol Cancer

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The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta‐analysis and trial sequential analysis

Cao

Yang

Wang

2022

Intl Journal of Cancer

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Myosteatosis is a novel imaging biomarker for survival in gynecological cancer patients; however, the evidence is inconsistent. This meta‐analysis aims to investigate the impact of myosteatosis on overall survival in the gynecological oncology setting. Three databases (PubMed, EMBASE and Web of Science) were systematically searched for relevant literature up to October 30, 2021. A random‐effects model was used to evaluate the predictive effect of myosteatosis on overall survival in the gynecological cancer population. The Newcastle‐Ottawa Scale was used to assess the methodological quality of the included studies. Trial sequential analysis was used to control the risk of random errors. Twelve studies with a total of 2519 patients were included. Myosteatosis was associated with a 50% increased mortality risk (HR 1.50, 95% CI 1.24‐1.82, P < .001) in gynecological cancer patients. Subgroup analyses stratified by study design, statistical model, treatment, sample size and stage confirmed the predictive value of myosteatosis on survival. However, the prognostic ability of myosteatosis only was held in the American and European populations but lost in Asians. Additionally, myosteatosis was not associated with the increased mortality in endometrial and cervical cancers, except for ovarian cancers. Overall, myosteatosis is a powerful predictor of reduced overall survival in gynecological cancer patients.

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Sarcopenia and ovarian cancer survival: a systematic review and meta‐analysis

Ubachs

Ziemons

Minis‐Rutten

et al. 2019

J cachexia sarcopenia muscle

126

105

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BackgroundSarcopenia is the loss of skeletal muscle mass and function that occurs with advancing age and certain diseases. It is thought to have a negative impact on survival in cancer patients. Routine computed tomography imaging is often used to quantify skeletal muscle in cancer patients. Sarcopenia is defined by a low skeletal muscle index (SMI). Skeletal muscle radiation attenuation (SMRA) is used to define muscle quality. The primary aim of this meta‐analysis was to study the association between sarcopenia or SMRA and overall survival (OS) or complications in patients with ovarian cancer.MethodsMedline, Embase, CINAHL, and PEDro databases were searched from inception to 15 February 2019. Studies evaluating the prognostic effect of SMI and SMRA on ovarian cancer survival or surgical complications were included. Risk of bias and study quality were evaluated with the Quality in Prognosis Studies Instrument (QUIPS) according to the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.ResultsThe search strategy yielded 4262 hits in all four databases combined. Ten and eight studies were included for qualitative and quantitative analysis, respectively. Meta‐analysis revealed a significant association between the SMI and OS [0.007; hazard ratio (HR): 1.11, 95% confidence interval (CI): 1.03–1.20]. SMRA was also significantly associated with OS (P < 0.001; HR: 1.14, 95% CI: 1.08–1.20). Association between the SMI and surgical complications had borderline statistical significance (0.05; HR: 1.23, 95% CI: 1.00–1.52). The risk of bias assessed with QUIPS was high in all studies. The quality of the evidence was very low.ConclusionsWhereas our meta‐analysis indicated that a low SMI and low SMRA are associated with survival in ovarian cancer patients, the low quality of the source data precludes drawing definitive conclusions.

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Skeletal Muscle Attenuation (Sarcopenia) Predicts Reduced Overall Survival in Patients with Advanced Epithelial Ovarian Cancer Undergoing Primary Debulking Surgery

Abstract: Low MA was significantly associated with poor survival, especially in patients with residual tumor after PDS. MA assessment could be used for risk stratification after PDS.

Cited by 64 publications

References 41 publications

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta‐analysis and trial sequential analysis

Sarcopenia and ovarian cancer survival: a systematic review and meta‐analysis

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