title: Muscle composition measured by CT scan is a measurable predictor of overall survival in advanced ovarian cancer.
abstract: To assess the impact of muscle composition and sarcopenia on overall survival in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS).
  
  
  
  Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/1/2006 and 12/31/2012 were included. Patient variables and vital status were abstracted. Body composition was evaluated in a semi-automated process using Slice-O-Matic software v4.3 (TomoVision). Skeletal muscle area and mean skeletal muscle attenuation were recorded. Associations with overall survival were evaluated using Cox proportional hazards models and recursive partitioning.
  
  
  
  We identified 296 patients and 132 (44.6%) were classified as sarcopenic. The average mean skeletal muscle attenuation of the entire cohort was 33.4 Hounsfield units (HU). A multivariate model of overall risk of death included histology, residual disease, and mean skeletal attenuation. Among patients without residual disease, overall survival, but not progression free survival was significantly different between patients with low versus high mean skeletal attenuation (median survival, 2.8 vs. 3.3years). Among patients with residual disease, overall survival was significantly different between patients with low versus high mean skeletal attenuation ≥36.40 vs. <36.40 HU (median survival, 2.0 vs. 3.3years).
  
  
  
  Sarcopenia and low mean skeletal muscle attenuation are common in women undergoing PDS for advanced EOC. These factors are associated with poorer outcomes, and can be used in preoperative risk stratification and patient counseling. Further research into body composition and whether this risk factor can be altered via nutrition or fitness in this population is warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amanika
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Moynagh
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Francesco
authors.initials: F
authors.lastname: Multinu
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Young
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Langstraat
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
authors.affiliation: Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: mariani.andrea@mayo.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
mesh_terms: D000368:Aged; D001823:Body Composition; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D055948:Sarcopenia / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Body composition; Ovarian cancer; Overall survival; Sarcopenia; Skeletal muscle attenuation