Abstract
ObjectivesTo investigate the impact of computed tomography (CT)-based, artificial intelligence-driven waist skeletal muscle volume on survival outcomes in patients with endometrial cancer.MethodsWe retrospectively identified endometrial cancer patients who received primary surgical treatment between 2014 and 2018 and whose pre-treatment CT scans were available (n = 385). Using an artificial intelligence-based tool, the skeletal muscle area (cm2) at the third lumbar vertebra (L3) and the skeletal muscle volume (cm3) at the waist level were measured. These values were converted to the L3 skeletal muscle index (SMI) and volumetric SMI by normalisation with body height. The relationships between L3, volumetric SMIs, and survival outcomes were evaluated.ResultsSetting 39.0 cm2/m2 of L3 SMI as cut-off value for sarcopenia, sarcopenia (< 39.0 cm2/m2, n = 177) and non-sarcopenia (≥ 39.0 cm2/m2, n = 208) groups showed similar progression-free survival (PFS; p = 0.335) and overall survival (OS; p = 0.241). Using the median value, the low-volumetric SMI group (< 206.0 cm3/m3, n = 192) showed significantly worse PFS (3-year survival rate, 77.3% vs. 88.8%; p = 0.004) and OS (3-year survival rate, 92.8% vs. 99.4%; p = 0.003) than the high-volumetric SMI group (≥ 206.0 cm3/m3, n = 193). In multivariate analyses adjusted for baseline body mass index and other factors, low-volumetric SMI was identified as an independent poor prognostic factor for PFS (adjusted HR, 1.762; 95% CI, 1.051–2.953; p = 0.032) and OS (adjusted HR, 5.964; 95% CI, 1.296–27.448; p = 0.022).ConclusionsWaist skeletal muscle volume might be a novel prognostic biomarker in patients with endometrial cancer. Assessing body composition before treatment can provide important prognostic information for such patients.
Highlights
Endometrial cancer is a global burden, with 417,367 new cases estimated to occur annually [1]
Myometrial invasion ≥ 50% and lymphovascular space invasion (LVSI) were identified in 28.8% and 29.1% of the patients, respectively
In this single-institution, retrospective cohort study, we demonstrated the impact of pre-treatment sarcopenia and waist body composition on survival outcomes in patients with endometrial cancer
Summary
Endometrial cancer is a global burden, with 417,367 new cases estimated to occur annually [1]. In Korea, the incidence of endometrial cancer has increased progressively, and nowadays, it is the most common gynaecologic malignancy [3, 4]. The risk of endometrial cancer reportedly increased 1.5 times for overweight and over 2.5 times for obese women [6]. In a large cohort study in the USA, a significant trend was observed between higher BMI and increased risk of death from endometrial cancer [7]. Excess body fat and lack of muscle mass, known as sarcopenia, has attracted the attention of researchers for causing adverse survival outcomes in many malignancies, including breast [8, 9], lung [10], and gastric cancers [11]
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