Visceral abdominal fat measured by computer tomography as a prognostic factor for gynecological malignancies?

Abstract

IntroductionObesity is associated with increased incidence of ovarian (OC), cervical (CC) and endometrium cancer (EC). However, the impact of body composition (BC) on overall survival (OS), especially of visceral adipose tissue (VAT) is not yet understood.MethodsIn 189 women with gynecological malignancies (31 OC, 104 CC, 54 EC, mean age 62.9y; mean BMI 26.8 kg/m2; median follow-up 30.7months) with routine staging CT-scans at baseline (mean interval: 4.3 months), densitometric quantification of total (TAT), visceral, and subcutaneous-fat-area (SAT), inter-muscular-fat-area (IMFA), and skeletal-muscle-index (SMI) was performed to analyze the impact of BC on survival.ResultsWith a mean follow-up of 30.7 months 48 patients had died. We observed no significant differences regarding BMI, the adipose- and muscle-distribution between surviving and deceased women. Univariate analyses revealed no significant BC-parameter with impact on OS, which was confirmed by different multivariate models. A subgroup analysis of OC, CC and EC showed only a protective impact of SMI on survival in the subgroup of CC.ConclusionsDespite the increased incidence of gynecological malignancies in obese, we found no significant impact of BC including VAT on patient survival. Further studies with larger cohorts are needed to quantify BC and its metabolomic impact regarding treatment and prognosis.

Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis

“…Similarly, two recent studies22 25 included only in the systematic review found that lower skeletal muscle index was not correlated with poorer overall survival. Furthermore, two other studies26 27 confirmed the results of the meta-analysis, that the mean skeletal muscle index as a continuous variable was not predictive of overall survival.…”

“…The flow diagram is illustrated in Figure 1. Fifteen studies6–12 20–27 were included in this systematic review, of which six studies were included in the meta-analysis 6–12. (Online supplementary Table S2 lists all excluded studies9 18 28–33 and the reasons for exclusion.…”

“…The sample size ranged from 7420 to 323 patients 12. Three studies were performed in Germany,7 12 27 three in The Netherlands,9–11 five in the USA,12 20 23 25 26 three in Japan,21 22 24 and one in Austria 10. Fourteen studies were retrospective and one was prospective 20.…”

“…Ten of 15 studies reported a body mass index (median or mean) of 24.96 to 28.023 (kg/m 2 ). In 9 of 15 studies,6–8 10 12 21–23 26 patients underwent primary debulking surgery, followed by chemotherapy, two studies reported patients undergoing interval debulking surgery followed by chemotherapy,13 15 and in four studies patients underwent chemotherapy only 20 24 25 27. In all studies, more than 50% of patients had advanced ovarian cancer (stages III/IV).…”

“…In all studies, more than 50% of patients had advanced ovarian cancer (stages III/IV). Ten studies6–10 12 22 25–27 assessed skeletal muscle index at baseline, as a continuous variable in two studies26 27 or as a dichotomous variable with specific cut-off values in eight studies 6–10 12 22 25. Four studies assessed skeletal muscle radiodensity,6 8 10 12 as a continuous variable in one study8 or as dichotomous variable defined with specific cut-off values,6 10 12 four studies9 11 20 21 assessed skeletal muscle area, and four studies11 21 23 24 assessed psoas outcomes.…”