The association between low muscle mass and sarcopenic obesity, survival, and major complications in patients with advanced ovarian cancer undergoing primary cytoreductive surgery: A retrospective study

Abstract

Objective: The aim of this study is to determine whether imaging-derived estimates of muscle mass or sarcopenic obesity are associated with survival and surgery-related complications in patients with advanced epithelial ovarian cancer treated with primary cytoreductive surgery (PCS). Methods: A skeletal muscle index (SMI) was determined by normalizing the muscle area at the level of third lumbar vertebra with the patient's height. Patients with SMI <38.5 cm2/m2 were deemed to have low muscle mass, and those with SMI <38.5 cm2/m2 and body mass index >25 kg/m2 were deemed to be affected by sarcopenic obesity. The relationships between low SMI and sarcopenic obesity, 1-year, 3-year, and overall survival were studied with Cox regression and Kaplan–Meier methods. The effect of SMI and sarcopenic obesity on surgery-related major complications (Clavien–Dindo ≥ IIIB) was studied with logistic regression models. Results: Ninety-two patients were retrospectively included, of whom 35 (38.0 %) and 12 (13.0 %) had low muscle mass or were affected by sarcopenic obesity, respectively. Among 73 (79.3 %) patients with high-grade serous OC, the 1-year survival rates were 66.7 % and 95.3 % (hazard ratio [HR] 9.19 [95 % confidence interval (CI): 1.85–45.75]) and the 3-year survival rates were 58.3 % and 68.8 % (HR 2.95 [95 % CI: 1.10–7.92]) for patients with and without sarcopenic obesity, respectively. Neither low muscle mass nor sarcopenic obesity was associated with major complications. Conclusion: Sarcopenic obesity was a marker of poor 1-year and 3-year survival in patients with high-grade serous OC. Neither low muscle mass nor sarcopenic obesity was associated with major complications in PCS.