Association between CT-based body composition assessment and patient outcomes during neoadjuvant chemotherapy for epithelial ovarian cancer

Objective. The aim of this study was to characterize the body composition of patients undergoing neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer (EOC), identify factors associated with sarcopenia at diagno-sis, and evaluate the impact of pretreatment sarcopenia and changes in body composition parameters during therapy on perioperative and disease-related outcomes.Methods. Patients undergoing NACT for EOC between 2008 and 2020 were identified. Pre-treatment and post-treatment contrast-enhanced CT scans were reviewed to determine skeletal muscle index (SMI) and visceral ad-ipose tissue (VAT) area at the mid-fourth lumbar vertebral level. SMI and VAT were analyzed for association with clinical and treatment variables.Results. 174 patients were identified. Mean pretreatment SMI and VAT were 38.3 cm2/m2 & PLUSMN; 7.9 and 51.2 cm2/ m2 & PLUSMN; 34.3, respectively. Comparatively, mean post-treatment SMI and VAT were 37.8 cm2/m2 & PLUSMN; 7.9 and 43.7 cm2/m2 & PLUSMN; 29.7, respectively. Most patients exhibited an overall decrease in SMI from pretreatment to posttreat-ment scans. Caucasian race, older age, and lower body mass index at diagnosis were associated with lower pre-treatment SMI. Lower pre-treatment SMI was associated with lower surgical complexity scores (p < 0.001) and estimated blood loss (p = 0.029). Decrease in SMI after NACT was associated with increased rates of ICU admis-sions and length of stay. While there was no association between SMI and overall survival (OS) or progression -free survival (PFS), > 2% decrease per 100 days in VAT was significantly associated with worse OS. Conclusions. Patients with lower pretreatment SMI tend to undergo less complex surgery than those with higher SMI despite NACT. Decrease in VAT may be a potential indicator of worse OS. Information on body com-position can aid in clinical decision making in patients with EOC.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to characterize the body composition of ovarian cancer patients undergoing neoadjuvant chemotherapy (NACT) and evaluate its impact on surgical and disease-related outcomes. The results showed that skeletal muscle index (SMI) and visceral adipose tissue (VAT) were associated with clinical and treatment variables. Lower pre-treatment SMI was associated with less complex surgery, while a decrease in VAT was associated with worse overall survival.