The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery.
BACKGROUND
Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS).


METHODS
Ovarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm2/m2). Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression.


RESULTS
Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105-2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968-1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications.


CONCLUSIONS
Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival.
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: iris.rutten@mumc.nl.
I J G
IJ
Rutten
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: j.ubachs@student.maastrichtuniversity.nl.
J
J
Ubachs
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: r.kruitwagen@mumc.nl.
R F P M
RF
Kruitwagen
Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: d.vandijk@maastrichtuniversity.nl.
D P J
DP
van Dijk
GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Department of Radiology, Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands. Electronic address: r.beetstan@nki.nl.
R G H
RG
Beets-Tan
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: Leon.Massuger@radboudumc.nl.
L F A G
LF
Massuger
Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: steven.oldedamink@maastrichtuniversity.nl.
S W M
SW
Olde Damink
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: toon.van.gorp@mumc.nl.
T
T
Van Gorp
D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D010051:Ovarian Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D016658:Psoas Muscles / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Ovarian neoplasms; Postoperative complications; Prognosis; Sarcopenia; Survival; X-ray computed tomography