Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma
Abstract
:1. Introduction
2. Results
2.1. Analysis in All Patients
2.2. Subgroup Analysis in Sarcopenia Patients
2.3. Correlations between Body Compositio and Systemic Inflammatory Indices
3. Discussion
4. Materials and Methods
4.1. Study Population
4.2. CT Image Analysis and Definition of Sarcopenia
4.3. Data Collection
4.4. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | All (n = 179, %) | No Sarcopenia Group (n = 103, %) | Sarcopenia Group (n = 76, %) | p |
---|---|---|---|---|
Age, years | ||||
Mean ± SD | 57.5 ± 10.6 | 57.8 ± 11.1 | 57.0 ± 9.9 | 0.615 |
BMI 1, kg/m2 | ||||
Mean ± SD | 23.6 ± 3.2 | 24.7 ± 3·3 | 22.1 ± 2.3 | <0.001 |
Normal (18.5−22.9) | 81 (45.3) | 35 (34.0) | 46 (60.5) | <0.001 |
Overweight (23.0–24.9) | 52 (29.1) | 30 (29.1) | 22 (28.9) | |
Obesity (≥25.0) | 46 (25.7) | 38 (36.9) | 8 (10.5) | |
Comorbidities | ||||
Hypertension | 48 (26.8) | 28 (27.2) | 20 (26.3) | 0.897 |
Diabetes | 15 (8.4) | 10 (9.7) | 5 (6.6) | 0.455 |
Dyslipidemia | 21 (11.7) | 15 (14.6) | 6 (7.9) | 0.171 |
ASA score | 0.080 | |||
1 | 63 (35.2) | 31 (30.1) | 32 (42.1) | |
2 | 104 (58.1) | 67 (65.0) | 37 (48.7) | |
3 | 12 (6.7) | 5 (4.9) | 7 (9.2) | |
FIGO stage | 0.653 | |||
IIIA1 | 8 (4.5) | 5 (4.9) | 3 (3.9) | |
IIIA2 | 6 (3.4) | 4 (3.9) | 2 (2.6) | |
IIIB | 17 (9.5) | 9 (8.7) | 8 (10.5) | |
IIIC | 91 (50.8) | 50 (48.5) | 41 (53.9) | |
IVA | 10 (5.6) | 4 (3.9) | 6 (7.9) | |
IVB | 47 (26.3) | 31 (30.1) | 16 (21.1) | |
CA-125, IU/ml | ||||
Median (range) | 801.0 (5.1–24720.0) | 833.0 (7.0–10000.0) | 793.0 (5.1–24720.0) | 0.829 |
Primary treatment strategy | 0.046 | |||
PDS | 135 (75.4) | 72 (69.9) | 63 (82.9) | |
NAC | 44 (24.6) | 31 (30.1) | 13 (17.1) | |
Residual tumour after PDS/IDS | 0.336 | |||
No gross | 114 (63.7) | 67 (65.0) | 47 (61.8) | |
<1 cm | 44 (24.6) | 26 (25.2) | 18 (23.7) | |
1–2 cm | 10 (5.6) | 3 (2.9) | 7 (9.2) | |
≥2 cm | 11 (6.1) | 7 (6.8) | 4 (5.3) | |
Regimen of first-line chemotherapy | 0.368 | |||
Paclitaxel-Carboplatin | 161 (89.9) | 93 (90.3) | 68 (89.5) | 0.393 |
Docetaxel-Carboplatin | 14 (7.8) | 9 (8.7) | 5 (6.6) | |
Paclitaxel-Carboplatin-Bevacizumab | 4 (2.2) | 1 (1.0) | 3 (3.9) | |
Main cycles of first-line chemotherapy | ||||
Median (range) | 6 (4–12) | 6 (4–12) | 6 (4–12) | 0.438 |
4–6 | 123 (68.7) | 70 (68.0) | 53 (69.7) | |
7–9 | 50 (27.9) | 31 (30.1) | 19 (25.0) | |
10–12 | 6 (3.4) | 2 (1.9) | 4 (5.3) | |
Recurrence | 140 (78.2) | 78 (75.7) | 62 (81.6) | 0.349 |
PSR 2 | 95 (53.1) | 47 (45.6) | 48 (63.2) | 0.031 |
PRR | 45 (25.1) | 31 (30.1) | 14 (18.4) | |
Platinum sensitivity | 0.075 | |||
Platinum-sensitive 3 | 134 (74.9) | 72 (69.9) | 62 (81.6) | |
Platinum-resistant | 45 (25.1) | 31 (30.1) | 14 (18.4) |
Characteristics | All (n = 179, %) | No Sarcopenia Group (n = 103, %) | Sarcopenia Group (n = 76, %) | p |
---|---|---|---|---|
Body composition at diagnosis 1 | ||||
Skeletal muscle area, cm2 | 98.0 (64.1–209.8) | 106.1 (84.8–209.8) | 88.1 (64.1–109.0) | <0.001 |
Total fat area, cm2 | 211.8 (42.2–612.5) | 230.7 (78.8–612.5) | 188.5 (42.2–458.2) | <0.001 |
Subcutaneous fat | 131.7 (34.4–310.8) | 154.0 (55.8–310.8) | 119.8 (34.4–252.0) | <0.001 |
Visceral fat | 70.4 (6.6–289.4) | 81.5 (11.2–289.4) | 59.6 (6.6–213.0) | 0.001 |
Muscle fat | 6.2 (0.7–36.2) | 6.5 (0.7–36.2) | 5.3 (1.2–31.6) | 0.103 |
Calculated body composition index 1 | ||||
Skeletal muscle index (SMI), cm2/m2 | 40.3 (27.1–79.2) | 42.6 (39.0–79.2) | 36.3 (27.1–39.0) | <0.001 |
Fat-to-muscle ratio (FMR) | 2.1 (0.5–6.5) | 2.1 (0.8–6.5) | 2.1 (0.5–4.9) | 0.508 |
Visceral-to-subcutaneous fat ratio (VSR) | 0.5 (0.1–2.9) | 0.5 (0.1–1.4) | 0.4 (0.1–2.9) | 0.212 |
Skeletal muscle mass-to-visceral fat ratio (SVR) | 1.4 (0.3–14.2) | 1.3 (0.3–8.7) | 1.5 (0.5–14.2) | 0.178 |
Laboratory test at diagnosis 1 | ||||
Hemoglobin, g/dL | 12.2 (8.3–14.9) | 12.2 (9.1–14.9) | 12.4 (8.3–14.6) | 0.491 |
WBC count, 103/uL | 7.0 (1.5–17.0) | 6.9 (1.5–14.7) | 7.1 (3.5–17.0) | 0.417 |
Neutrophil (%) | 68.9 (28.0–92.0) | 68.9 (28.0–92.0) | 68.9 (47.0–83.0) | 0.734 |
Lymphocyte (%) | 21.7 (5.0–57.0) | 22.2 (5.0–57.0) | 21.2 (9.4–42.9) | 0.772 |
Monocyte (%) | 6.8 (0.7–20.9) | 6.8 (0.7–20.9) | 6.9 (3.7–16.0) | 0.335 |
Platelet count, 103/uL | 316.5 (95.0–698.0) | 312.0 (95.0–698.0) | 323.0 (159.0–634.0) | 0.355 |
Albumin, g/dL | 3.9 (2.3–5.1) | 3.8 (2.3–4.6) | 4.0 (2.4–5.1) | 0.128 |
Calculated inflammatory index 1 | ||||
Neutrophil-to-lymphocyte ratio (NLR) | 3.2 (0.5–18.4) | 3.1 (0.5–18.4) | 3.2 (1.2–8.8) | 0.945 |
Monocyte-to-lymphocyte ratio (MLR) | 0.3 (0.1–0.9) | 0.3 (0.1–0.9) | 0.3 (0.1–0.9) | 0.378 |
Platelet-to-lymphocyte ratio (PLR) | 204.9 (71.6–768.5) | 208.3 (71.6–768.5) | 204.7 (77.2–628.1) | 0.923 |
Calculated nutritional index | ||||
Prognostic nutritional index (PNI) 2 | ||||
Mean ± SD | 46.0 ± 7.0 | 45.3 ± 7.0 | 47.0 ± 6.9 | 0.100 |
Characteristics | n | (A) Progression-Free Survival | (B) Overall Survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate Analysis | Multivariate Analysis | Univariate Analysis | Multivariate Analysis | ||||||||||
HR | 95% CI | p | aHR | 95% CI | p | HR | 95% CI | p | aHR | 95% CI | p | ||
Age, years | |||||||||||||
<58 | 94 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
≥58 | 85 | 1.558 | 1.116–2.175 | 0.009 | 1.458 | 1.024–2.077 | 0.037 | 1.551 | 0.919–2.618 | 0.101 | 1.213 | 0.692–2.127 | 0.500 |
FIGO stage | |||||||||||||
III | 122 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
IV | 57 | 1.342 | 0.944–1.908 | 0.101 | 1.216 | 0.820–1.805 | 0.330 | 1.490 | 0.861–2.579 | 0.154 | 1.256 | 0.690–2.288 | 0.456 |
CA-125, IU/ml | |||||||||||||
<800 | 89 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
≥800 | 90 | 1.164 | 0.835–1.622 | 0.370 | 1.140 | 0.811–1.602 | 0.451 | 1.110 | 0.660–1.867 | 0.695 | 0.964 | 0.560–1.660 | 0.894 |
Primary treatment strategy | |||||||||||||
PDS | 135 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
NAC | 44 | 1.669 | 1.151–2.419 | 0.007 | 1.380 | 0.902–2.113 | 0.138 | 2.376 | 1.392–4.057 | 0.002 | 2.000 | 1.096–3.649 | 0.024 |
Residual tumor after PDS/IDS | |||||||||||||
No gross | 114 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
Gross | 65 | 1.568 | 1.119–2.198 | 0.009 | 1.504 | 1.068–2.119 | 0.020 | 2.169 | 1.286–3.658 | 0.004 | 2.142 | 1.258–3.647 | 0.005 |
BMI, kg/m2 | |||||||||||||
Normal (18.5−22.9) | 81 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
Overweight (23.0−24.9) | 52 | 0679 | 0.449–1.029 | 0.068 | 0.656 | 0.429–1.004 | 0.052 | 0.728 | 0.366–1.450 | 0.367 | 0.707 | 0.347–1.437 | 0.338 |
Obesity (≥25.0) | 46 | 1.184 | 0.799–1.755 | 0.399 | 1.132 | 0.742–1.726 | 0.564 | 1.638 | 0.909–2.951 | 0.100 | 1.261 | 0.661–2.405 | 0.481 |
Sarcopenia | |||||||||||||
No | 103 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
Yes | 76 | 0.879 | 0629–1.228 | 0.451 | 1.292 | 0.906–1.843 | 0.157 | 0.747 | 0.436–1.280 | 0.289 | 0.870 | 0.488–1.550 | 0.636 |
Characteristics | FMR Low Group (n = 38, %) | FMR High Group (n = 38, %) | p |
---|---|---|---|
Age, years | |||
Mean ± SD | 54.0 ± 8.2 | 60.1 ± 10.6 | 0.006 |
BMI 1, kg/m2 | |||
Mean ± SD | 20.7 ± 1.5 | 23.6 ± 1.9 | <0.001 |
Normal (18.5–22.9) | 33 (86.8) | 13 (34.2) | <0.001 |
Overweight (23.0–24.9) | 5 (13.2) | 17 (44.7) | |
Obesity (≥25.0) | 0 | 8 (21.1) | |
Comorbidities | |||
Hypertension | 7 (18.4) | 13 (34.2) | 0.118 |
Diabetes | 3 (7.9) | 2 (5.3) | >0.999 |
Dyslipidemia | 0 | 6 (15.8) | 0.025 |
ASA score | 0.466 | ||
1 | 16 (42.1) | 16 (42.1) | |
2 | 20 (52.6) | 17 (44.7) | |
3 | 2 (5.3) | 5 (13.2) | |
FIGO stage | 0.613 | ||
III | 28 (73.7) | 26 (68.4) | |
IV | 10 (26.3) | 12 (31.6) | |
CA-125, IU/ml | |||
Median (range) | 793.0 (13.0–24720.0) | 712.5 (5.1–7821.0) | 0.949 |
Primary treatment strategy | 0.361 | ||
PDS | 33 (86.8) | 30 (78.9) | |
NAC | 5 (13.2) | 8 (21.1) | |
Residual tumour after PDS/IDS | 0.533 | ||
No gross | 23 (60.5) | 24 (63.2) | |
<1 cm | 11 (28.9) | 7 (18.4) | |
1–2 cm | 2 (5.3) | 5 (13.2) | |
≥2 cm | 2 (5.3) | 2 (5.3) | |
Regimen of first-line chemotherapy | 0.306 | ||
Paclitaxel-Carboplatin | 36 (94.7) | 32 (84.2) | |
Docetaxel-Carboplatin | 1 (2.6) | 4 (10.5) | |
Paclitaxel-Carboplatin-Bevacizumab | 1 (2.6) | 2 (5.3) | |
Main cycles of first-line chemotherapy | |||
Median (range) | 6 (4–12) | 6 (4–12) | 0.374 |
4–6 | 28 (73.7) | 25 (65.8) | 0.725 |
7–9 | 8 (21.1) | 11 (28.9) | |
10–12 | 2 (5.3) | 2 (5.3) | |
Recurrence | 30 (78.9) | 32 (842) | 0.554 |
PSR 2 | 24 (63.2) | 24 (63.2) | 0.638 |
PRR | 6 (15.8) | 8 (21.1) | |
Platinum sensitivity | 0.554 | ||
Platinum-sensitive 3 | 32 (84.2) | 30 (78.9) | |
Platinum-resistant | 6 (15.8) | 8 (21.1) |
Characteristics | FMR low group (n = 38, %) | FMR high group (n = 38, %) | p |
---|---|---|---|
Body composition at diagnosis 1 | |||
Skeletal muscle area, cm2 | 89.8 (74.5–109.0) | 86.4 (64.1–104.8) | 0.094 |
Total fat area, cm2 | 141.5 (42.2–199.3) | 228.1 (166.0–458.2) | <0.001 |
Subcutaneous fat | 97.1 (34.4–165.4) | 138.3 (54.6–252.0) | <0.001 |
Visceral fat | 35.2 (6.6–79.4) | 82.1 (30.1–213.0) | <0.001 |
Muscle fat | 3.8 (1.2–15.2) | 7.8 (2.3–31.6) | <0.001 |
Calculated body composition index 1 | |||
Skeletal muscle index (SMI), cm2/m2 | 36.0 (27.1–39.0) | 37.4 (28.7–39.0) | 0.228 |
Fat-to-muscle ratio (FMR) | 1.6 (0.5–2.1) | 2.6 (2.1–4.8) | <0.001 |
Visceral-to-subcutaneous fat ratio (VSR) | 0.3 (0.1–1.3) | 0.6 (0.2–2.9) | 0.001 |
Skeletal muscle mass-to-visceral fat ratio (SVR) | 2.5 (1.0–14.2) | 1.1 (0.5–2.6) | <0.001 |
Laboratory test at diagnosis 1 | |||
Hemoglobin, g/dL | 12.1 (8.3–14.6) | 12.5 (9.2–14.3) | 0.569 |
WBC count, 103/uL | 7.4 (3.5–15.3) | 6.9 (4.1–17.0) | 0.971 |
Neutrophil (%) | 69.7 (47.0–83.0) | 68.4 (49.7–81.2) | 0.646 |
Lymphocyte (%) | 21.5 (9.4–37.0) | 21.2 (9.7–42.9) | 0.893 |
Monocyte (%) | 7.2 (3.7–16.0) | 6.5 (4.5–13.5) | 0.557 |
Platelet count, 103/uL | 323.5 (159.0–634.0) | 3225 (202.0–564.0) | 0.383 |
Albumin, g/dL | 3.9 (2.8–5.0) | 4.0 (2.4–5.1) | 0.521 |
Calculated inflammatory index 1 | |||
Neutrophil-to-lymphocyte ratio (NLR) | 3.2 (1.4–8.8) | 3.3 (1.2–8.4) | 0.884 |
Monocyte-to-lymphocyte ratio (MLR) | 0.3 (0.1–0.8) | 0.3 (0.1–0.9) | 0.771 |
Platelet-to-lymphocyte ratio (PLR) | 201.0 (77.2–547.0) | 211.2 (97.3–682.1) | 0.633 |
Calculated nutritional index | |||
Prognostic nutritional index (PNI) 2 | |||
Mean ± SD | 46.7 (34.5–59.1) | 48.2 (27.7–64.0) | 0.357 |
Characteristics | n | (A) Progression-Free Survival | (B) Overall Survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate Analysis | Multivariate Analysis | Univariate Analysis | Multivariate Analysis | ||||||||||
HR | 95% CI | p | aHR | 95% CI | p | HR | 95% CI | p | aHR | 95% CI | p | ||
Age, years | |||||||||||||
<58 | 44 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
≥58 | 32 | 1.934 | 1.158–3.229 | 0.012 | 1.905 | 1.065–3.407 | 0.030 | 1.593 | 0.669–3.795 | 0.293 | 1.041 | 0.417–2.598 | 0.932 |
FIGO stage | |||||||||||||
III | 54 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
IV | 22 | 1.063 | 0.612–1.845 | 0.829 | 0.917 | 0.484–1.739 | 0.791 | 1.394 | 0.557–3.488 | 0.487 | 0.947 | 0.345–2.594 | 0.915 |
CA-125, IU/ml | |||||||||||||
<800 | 39 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
≥800 | 37 | 0.933 | 0.563–1.546 | 0.787 | 0.863 | 0.492–1.514 | 0.608 | 0.999 | 0.424–2.354 | 0.998 | 1.171 | 0.414–3.314 | 0.766 |
Primary treatment strategy | |||||||||||||
PDS | 63 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
NAC | 13 | 1.456 | 0.773–2.742 | 0.245 | 1.254 | 0.594–2.644 | 0.553 | 2.933 | 1.177–7.309 | 0.021 | 3.310 | 1.096–10.000 | 0.034 |
Residual tumor after PDS/IDS | |||||||||||||
No gross | 47 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
Gross | 29 | 2.274 | 1.363–3.795 | 0.002 | 2.270 | 1.334–3.861 | 0.003 | 3.587 | 1.442–8.922 | 0.006 | 4.377 | 1.655–11.578 | 0.003 |
BMI, kg/m2 | |||||||||||||
Normal (18.5−22.9) | 46 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
Overweight (23.0−24.9) | 22 | 0.921 | 0.517–1.641 | 0.780 | 0.846 | 0.440–1.624 | 0.615 | 1.024 | 0.383–2.740 | 0.962 | 0.783 | 0.244–2.517 | 0.682 |
Obesity (≥25.0) | 8 | 1.407 | 0.648–3.051 | 0.388 | 0.937 | 0.370–2.376 | 0.892 | 1.726 | 0.482–6.178 | 0.401 | 0.356 | 0.065–1.935 | 0.232 |
Fat-to-muscle ratio (FMR) | |||||||||||||
<2.1 | 38 | 1 | − | − | 1 | − | − | 1 | − | − | 1 | − | − |
≥2.1 | 38 | 1.262 | 0.762–2.092 | 0.366 | 1.073 | 0.576–1.999 | 0.825 | 2.476 | 0.989–6.199 | 0.053 | 3.377 | 1.170–9.752 | 0.024 |
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Kim, S.I.; Kim, T.M.; Lee, M.; Kim, H.S.; Chung, H.H.; Cho, J.Y.; Song, Y.S. Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma. Cancers 2020, 12, 559. https://doi.org/10.3390/cancers12030559
Kim SI, Kim TM, Lee M, Kim HS, Chung HH, Cho JY, Song YS. Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma. Cancers. 2020; 12(3):559. https://doi.org/10.3390/cancers12030559
Chicago/Turabian StyleKim, Se Ik, Taek Min Kim, Maria Lee, Hee Seung Kim, Hyun Hoon Chung, Jeong Yeon Cho, and Yong Sang Song. 2020. "Impact of CT-Determined Sarcopenia and Body Composition on Survival Outcome in Patients with Advanced-Stage High-Grade Serous Ovarian Carcinoma" Cancers 12, no. 3: 559. https://doi.org/10.3390/cancers12030559