334 Sarcopenia in hiding: CT-assessed sarcopenia is a prognostic factor in ovarian cancer

Abstract

<h3>Introduction/Background*</h3> Cancer cachexia represents a paraneoplasmatic syndrome including weight loss and sarcopenia. Sarcopenia is defined as a progressive loss of skeletal mass and function. Although poor nutritional status is adversely linked with oncological outcomes in ovarian cancer (OC), there is a paucity of data on the prevalence and prognostic value of sarcopenia in such patients. The aim of this study was to ascertain whether sarcopenia is associated with survival outcomes in OC. <h3>Methodology</h3> MEDLINE, Scopus and Cochrane Database were searched for relevant references from inception until May 2021 in line with PRISMA guidelines. Observational studies (OSs) assessing the prevalence and prognostic impact of sarcopenia in OC were included. The methodologic index for non-randomized studies was used to evaluate the quality of the included studies. We pooled proportions to calculate the prevalence of sarcopenia, whilst dichotomous variables were assessed using hazard ratio (HR). Confidence intervals were set at 95%. Heterogeneity was assessed using Cochran’s Q test, with an I² &gt; 50% and p-value &lt;0.1 denoting significant inter-study heterogeneity. Statistical analysis was performed using the RevMan software version 5.3 and MedCalc. The level of statistical significance was set at p-value &lt; 0.05. <h3>Result(s)*</h3> Eighteen OSs were included. The studies were of moderate quality and characterised by significant clinical heterogeneity. Pooled results rendered a summary proportion of 41.91% [(95% CI 34.97% - 49.01%); I²=93.2%] for the outcome of sarcopenia prevalence. Our analysis demonstrated no significant impact of sarcopenia on progression-free survival (PFS) either in univariate data [HR=1.11, (95% CI 0.90 - 1.37), p-value=0.33; I²=45%] or multivariate data synthesis [HR=1.23, (95% CI 0.94 - 1.60), p-value=0.13; I²=56%]. Conversely, sarcopenia was significantly associated with poorer overall survival (OS) in both univariate [HR=1.27 (95% CI 1.05 - 1.54), p-value=0.02; I²=72%] and multivariate data synthesis [HR=1.31 (95% CI 1.11 - 1.55), p-value=0.002; I²=78%]. <h3>Conclusion*</h3> Baseline sarcopenia is seemingly an independent prognosticator in OC. Early identification and enrolment in physical and nutritional optimisation may improve oncological outcomes. Future larger prospective studies are warranted to draw firmer conclusions.