title: Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients.
abstract: Malnutrition, weight loss, and muscle wasting (sarcopenia) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival. Our objective is to investigate overall survival (OS) related to changes in skeletal muscle (SM) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking.
  
  
  
  Ovarian cancer patients (n = 123) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht (the Netherlands) between 2000 and 2014 were included retrospectively. Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra. Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves, and Cox-regression models were applied to test predictors of OS.
  
  
  
  Median OS for patients who lost SM (n = 83) was 916 ± 99 days, which was significantly different from median OS for patients who maintained or gained SM (n = 40), which was 1431 ± 470 days (P = 0.004). Loss of SM was also a significant predictor of OS in multivariable Cox-regression analysis (hazard ratio 1.773 (95%CI: 1.018-3.088), P = 0.043). Low baseline SM did not influence survival.
  
  
  
  Patients with ovarian cancer have a worse survival when they lose SM during neoadjuvant chemotherapy. Evaluation of low SM at a specific time point is not prognostic for OS. External and prospective validation of these findings is imperative. Nutritional, pharmacological, and/or physical intervention studies are necessary to establish whether SM impairment can be prevented to prolong ovarian cancer survival.
authors.affiliation: Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands.
authors.forename: Iris J G
authors.initials: IJ
authors.lastname: Rutten
authors.affiliation: Department of General Surgery Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University 6200 MD Maastricht The Netherlands.
authors.forename: David P J
authors.initials: DP
authors.lastname: van Dijk
authors.affiliation: Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands.
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands; Department of Radiology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; Department of Radiology Netherlands Cancer Institute 1006 BE Amsterdam The Netherlands.
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
authors.affiliation: Department of General Surgery Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University 6200 MD Maastricht The Netherlands.
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.affiliation: Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands.
authors.forename: Toon
authors.initials: T
authors.lastname: van Gorp
keywords: Body composition; Computed tomography; Induction chemotherapy; Ovarian neoplasms; Sarcopenia; Survival