Abstract
The purpose of this study was to investigate the impact of sarcopenia and body composition change during primary treatment on survival outcomes in patients with early cervical cancer. We retrospectively identified patients diagnosed with 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 cervical cancer who underwent primary radical hysterectomy between 2007 and 2019. From pre-treatment CT scans (n = 306), the skeletal muscle area at the third lumbar vertebra (L3) and the waist skeletal muscle volume were measured using an artificial intelligence-based tool. These values were converted to the L3 and volumetric skeletal muscle indices by normalization. We defined L3 and volumetric sarcopenia using 39.0 cm2/m2 and the first quartile (Q1) value, respectively. From pre- and post-treatment CT scan images (n = 192), changes (%) in waist skeletal muscle and fat volumes were assessed. With the use of Cox regression models, factors associated with progression-free survival (PFS) and overall survival (OS) were analyzed. Between the L3 sarcopenia and non-sarcopenia groups, no differences in PFS and OS were observed. In contrast, volumetric sarcopenia was identified as a poor prognostic factor for PFS (adjusted hazard ratio [aHR], 1.874; 95% confidence interval [CI], 1.028–3.416; p = 0.040) and OS (aHR, 3.001; 95% CI, 1.016–8.869; p = 0.047). During primary treatment, significant decreases in waist skeletal muscle (median, −3.9%; p < 0.001) and total fat (median, −5.3%; p < 0.001) were observed. Of the two components, multivariate analysis revealed that the waist fat gain was associated with worse PFS (aHR, 2.007; 95% CI, 1.009–3.993; p = 0.047). The coexistence of baseline volumetric sarcopenia and waist fat gain further deteriorated PFS (aHR, 2.853; 95% CI, 1.257–6.474; p = 0.012). In conclusion, baseline volumetric sarcopenia might be associated with poor survival outcomes in patients with early cervical cancer undergoing primary RH. Furthermore, sarcopenia patients who gained waist fat during primary treatment were at a high risk of disease recurrence.
Highlights
Cervical cancer is a major health problem, as it ranks the fourth highest incidence and mortality rates among cancers in women worldwide [1]
In multivariate analysis that adjusted for clinicopathologic factors, volumetric sarcopenia was identified as a poor prognostic factor for progression-free survival (PFS) and overall survival (OS) (Table 2)
We found that the pre-treatment or baseline L3 sarcopenia did not affect survival outcomes in patients with early cervical cancer who underwent primary radical hysterectomy (RH)
Summary
Cervical cancer is a major health problem, as it ranks the fourth highest incidence and mortality rates among cancers in women worldwide [1]. Age-standardized incidence rate of cervical cancer is higher in Korea than in the United States and other Western countries [2, 3]. Sarcopenia, characterized by the loss of skeletal muscle mass and function, recently emerged in the cancer research field, as it was associated with higher recurrence and mortality rates, surgical complications, and treatment-related toxicity [12,13,14,15]. Only few studies have investigated prognostic role of pre-treatment sarcopenia, resulting in conflicting results [16,17,18]. All these previous studies included patients who underwent primary concurrent chemoradiation therapy (CCRT) or radiation therapy (RT), rather than primary RH
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