The effects of neoadjuvant chemotherapy and interval debulking surgery on body composition in patients with ovarian cancer

Abstract

BackgroundThe aim of this study was to quantify changes in body composition during ovarian cancer treatment and relate these changes to rates of complete gross resection (CGR).MethodsOne hundred two patients with stage III or IV ovarian cancer who underwent neoadjuvant chemotherapy (NACT) followed by interval debulking surgery were a part of a prospectively collected database that included computed tomography scans at three time points—diagnosis, following NACT, and following debulking surgery. Skeletal muscle, visceral adipose, and subcutaneous adipose tissue volumes were obtained from a 30‐mm volumetric slab beginning at the third lumbar vertebrae.ResultsFollowing NACT, skeletal muscle volume was significantly reduced (352.5 to 335.0 cm3, P < 0.001), whereas adiposity was unchanged. Body mass index (BMI) and skeletal muscle volume were significantly lower in patients who achieved CGR (P < 0.05). When these patients were stratified by BMI, the significant association of skeletal muscle to CGR was limited to patients with a BMI < 25 kg/m2 (P = 0.007).ConclusionSkeletal muscle volume was significantly reduced in patients undergoing NACT for ovarian cancer. Non‐overweight patients were more likely to achieve CGR if they had lower skeletal muscle volume. Use of volumetric‐based measurement for ascertaining body composition should be explored further.

The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta‐analysis and trial sequential analysis

“…48,49 Either intra-or extramyocellular adipose can change the shapes of muscle fibers, slow nutritive blood flowing to myocyte and impair the strength and velocity of muscle contraction, 48 which would eventually provide a broad area for tumors to spread, increase surgical blood loss and extend operation time. 50 Evidence inferred that cancer patients with myosteatosis are unlikely to achieve complete resection, 30 and consequently postoperative residuals will lead to a cancer relapse and treatment failure. Moreover, few patients with SMD loss during treatment could complete chemotherapy or extended-field radiotherapy, leading to suboptimal treatment plans, such as delays, dose reductions and discontinuation of treatments.…”

“…Myocellular lipid accumulation promotes the secretion of several mediators (eg, inflammatory kinases and reactive oxygen species) or free fatty acids, which cause insulin resistance, activate cancer cell proliferation and invasiveness and impact prognosis 48,49 . Either intra‐ or extramyocellular adipose can change the shapes of muscle fibers, slow nutritive blood flowing to myocyte and impair the strength and velocity of muscle contraction, 48 which would eventually provide a broad area for tumors to spread, increase surgical blood loss and extend operation time 50 . Evidence inferred that cancer patients with myosteatosis are unlikely to achieve complete resection, 30 and consequently postoperative residuals will lead to a cancer relapse and treatment failure.…”