Abstract
ObjectiveTo determine the predictive value of lumbar skeletal muscle mass and density for postoperative outcomes in older women with advanced stage ovarian cancer. MethodsA multicenter, retrospective cohort study was performed in women ≥ 70 years old receiving surgery for primary, advanced stage ovarian cancer. Skeletal muscle mass and density were assessed in axial CT slices on level L3. Low skeletal muscle mass was defined as skeletal muscle index < 38.50 cm2/m2. Low skeletal muscle density was defined as one standard deviation below the mean (muscle attenuation < 22.55 Hounsfield Units). The primary outcome was any postoperative complication ≤ 30 days after surgery. Secondary outcomes included severe complications, infections, delirium, prolonged hospital stay, discharge destination, discontinuation of adjuvant chemotherapy and mortality. ResultsIn analysis of 213 patients, preoperative low skeletal muscle density was associated with postoperative complications ≤ 30 days after surgery (Odds Ratio (OR) 2.83; 95% Confidence Interval (CI) 1.41–5.67), severe complications (OR 3.01; 95%CI 1.09–8.33), infectious complications (OR 2.79; 95%CI 1.30–5.99) and discharge to a care facility (OR 3.04; 95%CI 1.16–7.93). Preoperative low skeletal muscle mass was only associated with infectious complications (OR 2.32; 95%CI 1.09–4.92). In a multivariable model, low skeletal muscle density was of added predictive value for postoperative complications (OR 2.57; 95%CI 1.21–5.45) to the strongest existing predictor functional impairment (KATZ-ADL ≥ 2). ConclusionLow skeletal muscle density, as a proxy of muscle quality, is associated with poor postoperative outcomes in older patients with advanced stage ovarian cancer. These findings can contribute to postoperative risk assessment and clinical decision making.
Highlights
In the Western world, ovarian cancer is the most lethal gynecological malignancy and is ranked as the fifth leading cause of cancer death among women. [1] The incidence of gynecological cancer in older women is increasing
As a proxy of muscle quality, is associated with poor postoperative outcomes in older patients with advanced stage ovarian cancer. These findings can contribute to postoperative risk assessment and clinical decision making
In this study we explored whether postoperative outcomes in older patients receiving surgery for ovarian cancer can be predicted by preoperative skeletal muscle mass and density
Summary
In the Western world, ovarian cancer is the most lethal gynecological malignancy and is ranked as the fifth leading cause of cancer death among women. [1] The incidence of gynecological cancer in older women is increasing. 47% of all new ovarian cancers are detected in patients aged 70 years and older [2] and most are diagnosed at an advanced stage. Women with advanced stage ovarian cancer receive either primary cytoreductive surgery followed by six cycles of platinum and taxane based chemotherapy, or three cycles of neoadjuvant chemotherapy (NACT), followed by interval cytoreductive surgery and three cycles of adjuvant chemotherapy. [7] In older patients with cancer, sarcopenia is associated with negative health outcomes such as postoperative complications, lower treatment tolerability, functional impairment and lower overall survival. [6] skeletal muscle mass and density might be predictors for poor postoperative outcomes and could be helpful in selecting patients who might benefit from an adjusted treatment strategy In Europe, consensus is achieved on the following definition by the European Working Group on Sarcopenia in Older People (EWGSOP): (1) Low muscle strength combined with (2) low muscle quantity or quality and/or (3) low physical performance. [7] Low muscle quantity (measured as skeletal muscle mass on a computed tomography (CT) scan) and quality (measured as skeletal muscle density on a CT scan) are hallmarks of sarcopenia. [7] In older patients with cancer, sarcopenia is associated with negative health outcomes such as postoperative complications, lower treatment tolerability, functional impairment and lower overall survival. [6] skeletal muscle mass and density might be predictors for poor postoperative outcomes and could be helpful in selecting patients who might benefit from an adjusted treatment strategy
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