Impact of quantitative body composition on survival in patients with epithelial ovarian cancer undergoing primary debulking surgery

Aim:

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).

Methods:

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.

Results:

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).

Conclusions:

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.