Sarcopenia and Skeletal Muscle Quality as Predictors of Postoperative Complication and Early Mortality in Gynecologic Cancer

Objective: This study aimed to evaluate the influence of sarcopenia and the indicators of skeletal muscle (SM) quality on surgical outcomes in women with ovarian and endometrial cancer who underwent oncologic surgery. Methods: Endometrial and ovarian cancer patients admitted between 2008 and 2015 and who had computerized tomography images available within 45 days before surgery were enrolled in a retrospective cohort (n = 250). Computerized tomography images at the third lumbar vertebrawere used to assess SM. Skeletalmuscle index (SMI) was calculated in the range from -29 to + 150 Hounsfield Units; reduced muscle attenuation (range, -29 to + 29 HU) was classified as low-radiodensity skeletal muscle index (LRSMI). By subtracting the LRSMI area from total SMI, high-radiodensity skeletal muscle index (HRSMI) was created. Sarcopenia was defined when SMI was less than 38.9 cm(2)/m(2). Multiple logistic regression evaluated predictors of surgical complications. Results: Patients in lower HRSMI quartiles and in the highest quartiles of LRSMI had more postoperative surgical complication and had prolonged hospital stay. Both sarcopenia and the quality indicators of SM were predictors of increased risk of surgical complication, HRSMI being the strongest predictor. However, in a combined adjustment with sarcopenia, only HRSMI remained in the model as an independent predictor for surgical complication. In addition, HRSMI was the only indicator associated with early mortality (<30 days). Conclusions: The indicators of SMquality were the most significant predictors of surgical complications. Classifying muscle quality in terms of low-radiodensity or high-radiodensity area is a promising strategy to understand the impact of SM quality on unfavorable surgical outcomes in cancer patients.