Sarcopenia is a predictor of chemotherapy response score at the time of interval debulking surgery in advanced epithelial ovarian carcinoma

Abstract

<h3>Objectives:</h3> To examine the relationship between sarcopenia as measured by skeletal muscle index (SMI) on CT and chemotherapy outcomes and pathologic response after neoadjuvant chemotherapy (NACT) in patients with advanced epithelial ovarian carcinoma (EOC). <h3>Methods:</h3> Our institutional database was retrospectively queried for all women with advanced EOC who underwent NACT between 2007-2020. Demographic and clinical variables including number of NACT cycles, dose reductions, and dose delays were collected. Treatment response by 3-tier pathologic chemotherapy response score (CRS) and residual disease at time of interval cytoreductive surgery were recorded. Pre-treatment and post-treatment contrast enhanced CT scans were reviewed by two subspecialty radiologists to determine baseline and post-treatment SMI. SMI was calculated by dividing total psoas muscle and paraspinal muscle area (m²) (measured at the level of L4 vertebrae by height (cm²) squared. Patients were stratified to account for change in SMI after NACT and grouped into patients with >2% decrease in SMI (group 1) and increase or ≤2% decrease in SMI (group 2). SMI was also analyzed as a continuous variable for association with demographic and clinical factors by Kruskal-Wallis test/Spearman's correlation (results summarized as median [25th, 75th percentiles]). <h3>Results:</h3> Among 77 patients who met inclusion criteria, there were no significant differences between stage at diagnosis, baseline performance status, frailty scores, number of NACT cycles, histology, or tumor grade between the two groups. However, pretreatment Ca125 was higher in patients in group 2 (p=0.031). When SMI was analyzed as a continuous variable, age at diagnosis was negatively associated with higher SMI (-0.47, (-0.63, -0.28, p=<0.001). Number of completed NACT cycles was negatively associated with higher SMI -0.23 (-0.43, -0.0, p=0.048). Lower CRS, indicating no/minimal chemotherapy response at the time of interval cytoreduction was associated with lower SMI (0.45, (0.01, 0.75), p=0.043) despite no difference in residual disease. <h3>Conclusions:</h3> Sarcopenia as measured by SMI is associated with older age and increased number of NACT cycles in our patient population. Additionally, sarcopenia was predictive of lower chemotherapy response at the time of interval cytoreduction. Data collection is ongoing to further delineate the relationship between sarcopenia and response to NACT.