Abstract
ObjectiveTo assess the association between loss of lumbar skeletal muscle mass and density during neoadjuvant chemotherapy (NACT) and postoperative complications after interval cytoreductive surgery (CRS) in older patients with ovarian cancer. Materials and methodsThis multicenter, retrospective cohort study included patients aged 70 years and older with primary advanced stage ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), treated with NACT and interval CRS. Skeletal muscle mass and density were retrospectively assessed using Skeletal Muscle Index (SMI) and Muscle Attenuation (MA) on routinely made Computed Tomography scans before and after NACT. Loss of skeletal muscle mass or density was defined as >2% decrease per 100 days in SMI or MA during NACT. ResultsIn total, 111 patients were included. Loss of skeletal muscle density during NACT was associated with developing any postoperative complication ≤30 days after interval CRS both in univariable (Odds Ratio (OR) 3.69; 95% Confidence Interval (CI) 1.57–8.68) and in multivariable analysis adjusted for functional impairment and WHO performance status (OR 3.62; 95%CI 1.27–10.25). Loss of skeletal muscle density was also associated with infectious complications (OR 3.67; 95%CI 1.42–9.52) and unintended discontinuation of adjuvant chemotherapy (OR 5.07; 95%CI 1.41–18.19). Unlike loss of skeletal muscle density, loss of skeletal muscle mass showed no association with postoperative outcomes. ConclusionIn older patients with ovarian cancer, loss of skeletal muscle density during NACT is associated with worse postoperative outcomes. These results could add to perioperative risk assessment, guiding the decision to undergo surgery or the need for perioperative interventions.
Highlights
Forty-seven percent of all new epithelial ovarian cancers are diagnosed in patients aged 70 years and older [1]
We investigated the association between loss of skeletal muscle mass and density during Neoadjuvant chemotherapy (NACT) and postoperative outcomes after interval cytoreductive surgery (CRS) in older patients with advanced ovarian cancer
Retrospective cohort study patients aged !70 years who were treated with NACT and interval CRS for primary ovarian carcinoma FIGO stage III or IV were included from three hospitals in the Netherlands (The Netherlands Cancer Institute (NKI), Amsterdam; University Medical Center Groningen (UMCG); and Reinier de Graaf (RDG), Delft)
Summary
Forty-seven percent of all new epithelial ovarian cancers are diagnosed in patients aged 70 years and older [1]. The percentage of older patients diagnosed with ovarian cancer has increased over time [2] and due to the ageing population this percentage is expected to increase further in the future. Neoadjuvant chemotherapy (NACT) with interval CRS is offered if primary CRS is considered not feasible due to extent of disease or poor patient condition [3]. Individual perioperative risk assessment can help clinicians and patients in shared decision making. It contributes to the decision whether or not to undergo surgery, or guide the need for perioperative interventions aiming to improve postoperative outcomes, such as prehabilitation [4]
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