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. 2021 Nov 16:11:718815.
doi: 10.3389/fonc.2021.718815. eCollection 2021.

Computed Tomography-Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

Maria Del Grande  1 , Stefania Rizzo  2   3 , Gabriele Maria Nicolino  4 , Ilaria Colombo  1 , Lorenzo Rossi  1 , Lucia Manganaro  5 , Filippo Del Grande  2   3
Affiliations

Computed Tomography-Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

Maria Del Grande et al. Front Oncol. .

Abstract

Purpose: To assess the association between computed tomography (CT)-derived quantitative measures of body composition profiling and chemotherapy-related complications, in terms of dose reduction, premature discontinuation of chemotherapy, and cycle delays in patients with ovarian cancer. Secondary purposes were to evaluate associations between sarcopenia and survival, and to evaluate differences in body composition profiling at baseline and after neoadjuvant chemotherapy.

Materials and methods: The study population was retrospectively selected from a database of patients with newly diagnosed ovarian cancer (any stage) referred to our Institution between Feb 2011 and Mar 2020. Clinical data were recorded, and CT images at the level of the 3rd lumbar vertebra were stored. By using specific software, skeletal muscle area (SMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were extracted. Skeletal muscle index (SMI) was then calculated. Statistical analysis was performed by logistic regression models to identify body composition features predictive of dose reduction, premature end of chemotherapy, and cycle delays. Kaplan-Meier analyses were performed to assess overall survival (OS) and progression-free survival (PFS). The log-rank test was used to determine differences in OS and PFS between sarcopenic and non-sarcopenic patients. Wilcoxon test was performed to compare body composition features before and after neoadjuvant chemotherapy (NACT).

Results: Sixty-nine patients were included. A significant association was found between VAT and cycle delays (OR = 1.01, z = 2.01, 95% CI: 1.00-1.02, p < 0.05), between SMA and early discontinuation of chemotherapy (OR = 1.03, z = 2.10, 95% CI: 1.00-1.05, p < 0.05), and between mean SMD and cycle delays (OR = 0.92, z = -2.70, 95%CI: 0.87-0.98, p < 0.01). No significant difference emerged for OS in sarcopenic and non-sarcopenic patients, nor in CT body composition features before and after NACT.

Conclusions: In ovarian cancer patients, CT-derived body composition profiling might predict the risk of chemotoxicity. In particular, VAT and SMD are associated with chemotherapy cycle delays, and SMA with early discontinuation of chemotherapy.

Keywords: body composition; chemotherapy; ovarian cancer; skeletal muscle area; visceral adipose tissue.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
An example of segmentation of skeletal muscle area (red), visceral adipose tissue (yellow), and subcutaneous adipose tissue (light blue) from an axial image at the level of L3 of a CT scan performed as routine pretreatment staging. The colored parts are quantified as areas (cm2) by the software. The excluded parts include abdominal organs, such as liver, kidneys, and bowel (dark gray), as well as bones, such as vertebral body and ribs (light gray and white).
Figure 2
Figure 2
Kaplan-Meier curve showing overall survival for total sample (A) and by sarcopenia (B). Median OS: 23 months (IQR: 29 months). 2-year OS rate: 77% (sarcopenic: 77%; non-sarcopenic: 78%); 5-year OS rate: 40% (sarcopenic: 39%; non-sarcopenic: 37%). The overall survival shows an overlap in the two groups divided according to sarcopenia.
Figure 3
Figure 3
Kaplan-Meier curve showing progression-free survival for total sample (A) and by sarcopenia (B). Median OS: 13 months (IQR: 17 months). 2-year PFS rate: 41% (sarcopenic: 35%; non-sarcopenic: 44%); 5-year PFS rate: 13% (sarcopenic: 21%; non-sarcopenic: 12%). The progression-free survival shows an overlap in the two groups divided according to sarcopenia.
See this image and copyright information in PMC

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