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Abstract
ObjectiveTumor cachexia is an important prognostic parameter in epithelial ovarian cancer (EOC). Tumor cachexia is characterized by metabolic and inflammatory disturbances. These conditions might be reflected by body composition measurements (BCMs) ascertained by pre-operative computed tomography (CT). Thus, we aimed to identify the prognostically most relevant BCMs assessed by pre-operative CT in EOC patients.MethodsWe evaluated muscle BCMs and well established markers of nutritional and inflammatory status, as well as clinical-pathological parameters in 140 consecutive patients with EOC. Furthermore, a multiplexed inflammatory marker panel of 25 cytokines was used to determine the relationship of BCMs with inflammatory markers and patient’s outcome. All relevant parameters were evaluated in uni- and multivariate survival analysis.ResultsMuscle attenuation (MA)—a well established BCM parameter—is an independent prognostic factor for survival in multivariate analysis (HR 2.25; p = 0.028). Low MA—reflecting a state of cachexia—is also associated with residual tumor after cytoreductive surgery (p = 0.046) and with an unfavorable performance status (p = 0.015). Moreover, MA is associated with Eotaxin and IL-10 out of the 25 cytokine multiplex marker panel in multivariate linear regression analysis (p = 0.021 and p = 0.047, respectively).ConclusionMA—ascertained by routine pre-operative CT—is an independent prognostic parameter in EOC patients. Low MA is associated with the inflammatory, as well as the nutritional component of cachexia. Therefore, the clinical value of pre-operative CT could be enhanced by the assessment of MA.
Highlights
Cancer cachexia is a significant factor contributing to the poor performance status and high mortality rate of cancer patients
Cancer cachexia involves a variety of catabolic proinflammatory cytokines, such as tumor necrosis factor alpha (TNFα) and interleukin (IL)-6, and anti-inflammatory cytokines such as IL-4 or IL-10 are involved in the pathogenesis of cancer associated metabolic disturbances [9, 10], with a negative impact on prognosis [11]
This study demonstrates that muscle attenuation (MA), which seems to be associated with cancer cachexia, is an independent prognostic parameter ascertained by routine pre-operative computed tomography (CT) in epithelial ovarian cancer (EOC) patients
Summary
Tumor cachexia is an important prognostic parameter in epithelial ovarian cancer (EOC). Tumor cachexia is characterized by metabolic and inflammatory disturbances. These conditions might be reflected by body composition measurements (BCMs) ascertained by preoperative computed tomography (CT). We aimed to identify the prognostically most relevant BCMs assessed by pre-operative CT in EOC patients. Editor: Kwong-Kwok Wong, The University of Texas MD Anderson Cancer Center, UNITED STATES. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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