Abstract
Background
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).
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: January 19, 2017
Accepted:
December 14,
2016
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
