Impact of quantitative body composition on survival in patients with epithelial ovarian cancer undergoing primary debulking surgery
20 September 2018 (online)
Evaluation of the impact of quantitative body composition using computed tomography (CT) on overall survival (OS) in patients with epithelial ovarian cancer (EOC) after primary debulking surgery (PDS).
Retrospective study of 323 EOC patients (FIGO IIIB-IV) determined by CT-imaging to skeletal muscle index (SMI) and muscle attenuation (MA- average Hounsfield units (HU)) at the level L3 skeletal muscle). Cut-off points for SMI were previously published. The optimal cut-off point for MA (32HU) was calculated by using Martingale residuals.
Sarcopenia defined by SMI< 38.5, < 39, and 41 cm2/m2 was detected in 29.4%, 33.7%, and 47.1%, respectively. However, none of this SMI cut-off-level was associated with inferior OS. Low MA was present in 21.1% (68//232) in the total cohort. Significant difference between patients with MA < 32/> 32HU were detected for median age (67 vs. 57 years), ECOG > 0 (13.2 vs. 3.1%), comorbidity (ACCI ≥4: 36.8 vs. 13.3%), median BMI (27 vs. 24 kg/m2), FIGO stage, histology (high-grade-serous 95.6 vs. 84.7%), and complete resection (38.2 vs. 68.2%).
Median OS in patients with MA < 32 vs. > 32HU was 28 vs. 56 months (p < 0.001). MA< 32HU remained significant for OS in multivariate analysis (HR 1.79, p = 0.003). Furthermore, MA< 32HU was a significant discriminator for OS in the prognostically poor population of patients with residual tumor (p = 0.015).
Low MA was significantly associated with poor survival, especially in patients with residual tumor after PDS. CT image analysis could be used to stratify patients in risk categories after PDS.