Loss of skeletal muscle density during neoadjuvant chemotherapy in older women with advanced stage ovarian cancer is associated with postoperative complications

Abstract

Objective: To 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 methods: This 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. Results: In 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) 1.57e8.68) and in multivariable analysis adjusted for functional impairment and WHO performance status (OR 3.62; 95%CI 1.27e10.25). Loss of skeletal muscle density was also associated with infectious complications (OR 3.67; 95%CI 1.42e9.52) and unintended discontinuation of adjuvant chemotherapy (OR 5.07; 95%CI 1.41e18.19). Unlike loss of skeletal muscle density, loss of skeletal muscle mass showed no association with postoperative outcomes. Conclusion: In 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.

Adverse effects of systemic cancer therapy on skeletal muscle: myotoxicity comes out of the closet

“…Here, male colorectal cancer patients with metastatic disease showed muscle loss of À8.3%/100 days [25], testicular cancer patients showed muscle loss up to À11.9%/100 days [20,21], and four new studies in neoadjuvant chemotherapy for esophageal/esophagogastric cancer, which has a high proportion of male individuals [16][17][18][19], showed relatively high intensity of muscle change (À7.2% to À9%/100 days). Muscle loss in the intermediate range were seen in a series of single reports, including Hodgkin's Lymphoma (À5.6%/ 100 days) [22], neoadjuvant chemotherapy for advanced ovarian cancer (6%/100 d) [15], curative intent chemoradiotherapy for head and neck cancer (À3.8%/100 days) [26] and targeted therapy cabozantinib in renal cell carcinoma (À4.6%/100 days) [27].…”

Integration of body composition data in developing a Random Survival Forest model for the Prognosis of Locally Advanced Cervical Cancer patients treated with definitive Chemoradiotherapy

“…Sarcopenia and cachexia often occur in cancer patients. SMD, as a radiological characteristic, can adequately re ect ongoing cachexia as well as sarcopenia [33,34]. Low SMD is indicative of higher adipose tissue production and muscular in ltration, thereby re ecting the poor quality of skeletal muscle [35].…”

“…Low SMD is indicative of higher adipose tissue production and muscular in ltration, thereby re ecting the poor quality of skeletal muscle [35]. Furthermore, pretreatment SMD is con rmed to be associated with the in ammatory response, chemotherapy-induced toxicity, and postoperative complications in various cancers [34,36,37].…”

Pre-Operative Malnutrition in Patients with Ovarian Cancer: What Are the Clinical Implications? Results of a Prospective Study

“…Approximately 30-80% of all patients with cancer are malnourished or cachectic [4][5][6][7]. This is influenced by tumor type, location, stage, and current therapy [6][7][8].…”