Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS).
Ovarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm2/m2). Cox-regression and Kaplan–Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression.
Kaplan–Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105–2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968–1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications.
Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Surgical Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global cancer statistics, 2012.CA Cancer J Clin. 2015; 65: 87-108
- Ten-year relative survival for epithelial ovarian cancer.Obstet Gynecol. 2012; 120: 612-618
- Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer.N Engl J Med. 2010; 363: 943-953
- Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO).Cancer. 2009; 115: 1234-1244
- Cachexia in cancer patients.Nat Rev Cancer. 2002; 2: 862-871
- Definition and classification of cancer cachexia: an international consensus.Lancet Oncol. 2011; 12: 489-495
- Visceral adipose tissue: relations between single-slice areas and total volume.Am J Clin Nutr. 2004; 80: 271-278
- Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.J Appl Phys. 2004; 97: 2333-2338
- A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care.Appl Physiol Nutr Metab. 2008; 33: 997-1006
- Body composition and outcome in patients undergoing resection of colorectal liver metastases.Br J Surg. 2012; 99: 550-557
- Decreased skeletal muscle mass is associated with an increased risk of mortality after radical nephrectomy for localized renal cell cancer.J Urol. 2016; 195: 270-276
- Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index.J Clin Oncol. 2013; 31: 1539-1547
- Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review.Eur J Cancer. 2016; 57: 58-67
- Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients.J Cachexia Sarcopenia Muscle. 2016 Sep; 7: 458-466
- Nutritional status, CT body composition measures and survival in ovarian cancer.Gynecol Oncol. 2013; 129: 548-553
- Skeletal muscle depletion and markers for cancer cachexia are strong prognostic factors in epithelial ovarian cancer.PLoS One. 2015; 10: e0140403
- Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery.Br J Cancer. 2012; 107: 931-936
- Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy.Gastric Cancer. 2016 Jul; 19: 986-993
- Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly.Am J Clin Nutr. 2016; 103: 830-840
- Cancer cachexia prevention via physical exercise: molecular mechanisms.J Cachexia Sarcopenia Muscle. 2013; 4: 111-124
- Therapeutic exercise in cancer cachexia.Crit Rev Oncog. 2012; 17: 285-292
- Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training.J Cachexia Sarcopenia Muscle. 2015; 6: 197-207
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Finding optimal cutpoints for continuous covariates with binary and time-to-event outcomes. Technical Report Series #79.Mayo Foundation, 2006: 1-26
- Body-composition differences between African American and white women: relation to resting energy requirements.Am J Clin Nutr. 2004; 79: 780-786
- Molecular genetic studies of gene identification for sarcopenia.Hum Genet. 2012; 131: 1-31
- Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality.Cancer. 2014; 120: 2910-2918
- Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.Lancet Oncol. 2008; 9: 629-635
- Neoadjuvant chemotherapy in advanced ovarian cancer: on what do we agree and disagree?.Gynecol Oncol. 2013; 128: 6-11
Published online: January 19, 2017
Accepted: December 14, 2016
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.