Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients

Abstract

BackgroundMalnutrition, weight loss, and muscle wasting (sarcopenia) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival. Our objective is to investigate overall survival (OS) related to changes in skeletal muscle (SM) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking.MethodsOvarian cancer patients (n = 123) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht (the Netherlands) between 2000 and 2014 were included retrospectively. Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra. Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves, and Cox‐regression models were applied to test predictors of OS.ResultsMedian OS for patients who lost SM (n = 83) was 916 ± 99 days, which was significantly different from median OS for patients who maintained or gained SM (n = 40), which was 1431 ± 470 days (P = 0.004). Loss of SM was also a significant predictor of OS in multivariable Cox‐regression analysis (hazard ratio 1.773 (95%CI: 1.018–3.088), P = 0.043). Low baseline SM did not influence survival.ConclusionsPatients with ovarian cancer have a worse survival when they lose SM during neoadjuvant chemotherapy. Evaluation of low SM at a specific time point is not prognostic for OS. External and prospective validation of these findings is imperative. Nutritional, pharmacological, and/or physical intervention studies are necessary to establish whether SM impairment can be prevented to prolong ovarian cancer survival.

Activity Behaviors and Physiological Characteristics of Women With Advanced-Stage Ovarian Cancer: A Preliminary Cross-sectional Investigation

“…These findings need to be confirmed in larger studies. Many survivors in certain cancer groups experience detrimental body composition changes (ie, increase in fat mass, loss of muscle, and/or bone mass) due to the combined impact of cancer, treatment, and reduced PA. 38 Furthermore, previous OC research reports low muscle mass in 29% to 50% of women and low muscle density and 35% of women, respectively, at OC diagnosis 39,40 and bone loss in the first year after OC diagnosis. 41 Future longitudinal studies are warranted to assess body composition changes through the OC trajectory.…”

Screening for low muscularity in colorectal cancer patients: a valid, clinic‐friendly approach that predicts mortality

“…In addition, examination of whether the linear measures method is sensitive to change over time would also be relevant, as muscle loss during cancer treatment has been shown in colorectal and other cancers to be strongly associated with risk of death 54, 55. Because this was a test of the validity of the screening method, we included both pre‐surgical and post‐surgical scans in this analysis; the validity of the method and associations with mortality were very similar when we restricted to only pre‐surgical scans.…”

A Physiological Profile of Ovarian Cancer Survivors to Inform Tailored Exercise Interventions and the Development of Exercise Oncology Guidelines

“…However, current data do not confirm an association between low muscle mass at diagnosis and OC survival. 46,59,61 An important finding by Rutten et al 59 is the association of skeletal muscle loss during neoadjuvant chemotherapy with decreased survival, although this finding requires further confirmation.…”

“…44,52,57,58 The presence of ascites and a high body fat percentage at any time point will ''inflate'' BMI values and mask muscle wasting, a consequence of malnourishment. 59 In addition to BMI, body composition measures can provide much needed objective data to identify OC survivors with low muscle mass and/or excess body fat in need of dietary and exercise interventions.…”