Abstract
PurposeTo assess the association between computed tomography (CT)-derived quantitative measures of body composition profiling and chemotherapy-related complications, in terms of dose reduction, premature discontinuation of chemotherapy, and cycle delays in patients with ovarian cancer. Secondary purposes were to evaluate associations between sarcopenia and survival, and to evaluate differences in body composition profiling at baseline and after neoadjuvant chemotherapy.Materials and MethodsThe study population was retrospectively selected from a database of patients with newly diagnosed ovarian cancer (any stage) referred to our Institution between Feb 2011 and Mar 2020. Clinical data were recorded, and CT images at the level of the 3rd lumbar vertebra were stored. By using specific software, skeletal muscle area (SMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were extracted. Skeletal muscle index (SMI) was then calculated. Statistical analysis was performed by logistic regression models to identify body composition features predictive of dose reduction, premature end of chemotherapy, and cycle delays. Kaplan-Meier analyses were performed to assess overall survival (OS) and progression-free survival (PFS). The log-rank test was used to determine differences in OS and PFS between sarcopenic and non-sarcopenic patients. Wilcoxon test was performed to compare body composition features before and after neoadjuvant chemotherapy (NACT).ResultsSixty-nine patients were included. A significant association was found between VAT and cycle delays (OR = 1.01, z = 2.01, 95% CI: 1.00–1.02, p < 0.05), between SMA and early discontinuation of chemotherapy (OR = 1.03, z = 2.10, 95% CI: 1.00–1.05, p < 0.05), and between mean SMD and cycle delays (OR = 0.92, z = −2.70, 95%CI: 0.87–0.98, p < 0.01). No significant difference emerged for OS in sarcopenic and non-sarcopenic patients, nor in CT body composition features before and after NACT.ConclusionsIn ovarian cancer patients, CT-derived body composition profiling might predict the risk of chemotoxicity. In particular, VAT and SMD are associated with chemotherapy cycle delays, and SMA with early discontinuation of chemotherapy.
Highlights
Epithelial ovarian cancer (OC) is the fifth cause of cancer death in the female population in developed countries, with 21,410 new cases estimated in the United States in 2021 [1]
The following clinical data were collected: age at diagnosis; weight and height to calculate the body mass index (BMI) and to further divide patients into three groups according to the World Health Organization (WHO) definition of obesity [22] into underweight (BMI 25); International Federation of Gynecology and Obstetrics (FIGO) stage; neoadjuvant chemotherapy (NACT), if any; dose reduction of any chemotherapy agent compared to first cycle; premature discontinuation of chemotherapy due to toxicity; cycle delays >2 weeks due to chemotherapy-induced adverse events; blood parameters within 30 days from the date of Computed tomography (CT), including lactate dehydrogenase, albumin, hemoglobin, white blood cell count, lymphocyte count
The laboratory tests before the first chemotherapy cycle showed that most patients had normal white blood cell count (7.27 ± 3.30 × 109/L), albumin (34.90 ± 7.70 g/L), hemoglobin (120.79 ± 18.15 g/L), and elevated lactate dehydrogenase (551.84 ± 355.14 U/L)
Summary
Epithelial ovarian cancer (OC) is the fifth cause of cancer death in the female population in developed countries, with 21,410 new cases estimated in the United States in 2021 [1]. The current standard treatment for OC is primary cytoreductive surgery with complete resection of all macroscopic disease [2], followed by adjuvant platinum-based chemotherapy. Sarcopenia refers to a skeletal muscle loss over two standard deviations below the mean of a young healthy adult group and can occur secondarily to a systemic disease, such as cancer [6]. Sarcopenia has been associated with worse prognosis after curative surgery for localized disease, as well as during and after systemic therapy for advanced or metastatic disease [7,8,9,10]. Sarcopenia and cachexia in cancer patients may be found in solid tumor, such as ovarian, especially in the metastatic setting, even though associated with high body mass index [11, 12]
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