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. 2025 Apr 11;25(1):671.
doi: 10.1186/s12885-025-14050-x.

The impact of CT-based adipose tissue distribution and sarcopenia on treatment outcomes in patients with high-risk soft tissue sarcoma

Luc M Berclaz  1   2 , Dorit Di Gioia  3 , Michael Völkl  3 , Vindi Jurinovic  4 , Alexander Klein  5 , Hans Roland Dürr  5 , Thomas Knösel  6 , Bianca Teodorescu  7 , Stefan Enßle  7 , Michaela Rippl  8 , Michael von Bergwelt-Baildon  3   9 , Wolfgang G Kunz  10 , Lars H Lindner  3 , Anton Burkhard-Meier  3   11
Affiliations

The impact of CT-based adipose tissue distribution and sarcopenia on treatment outcomes in patients with high-risk soft tissue sarcoma

Luc M Berclaz et al. BMC Cancer. .

Abstract

Background: The prognostic and predictive value of obesity and sarcopenia remains poorly defined in patients with high-risk soft tissue sarcoma (HR-STS). We sought to correlate clinical outcomes with CT-based body composition parameters in patients with HR-STS undergoing a multimodal preoperative therapy. The impact of radiologic and histopathologic response to preoperative treatment was correlated with individual fat and muscle distribution.

Methods: Patients with locally advanced non-abdominal HR-STS and treatment with preoperative chemotherapy + regional hyperthermia (RHT) +/- radiotherapy (RT) followed by surgery between 2015 and 2022 were retrospectively evaluated. Body composition parameters measured on baseline CT scans were correlated with clinical outcomes including event-free survival (EFS) and overall survival (OS) as well as radiologic and histopathologic treatment response.

Results: A total of 85 patients were included. Body composition parameters showed no significant correlation with radiologic or histopathologic treatment response. High total fat indices such as the total fat index (TFI, HR 3.56, p = 0.005) and high total fat to muscle ratio (FMR, HR 3.22, p = 0.020) were strongly associated with poor OS. Parameters for sarcopenia including skeletal muscle index (SMI) were not significantly linked to survival outcomes.

Conclusion: High fat indices and a high FMR are strong predictors of poor OS in patients with HR-STS. Larger studies are warranted to further clarify the prognostic impact of sarcopenia and the predictive value of body composition parameters on preoperative treatment response.

Keywords: Chemotherapy; EORTC-STBSG; Fat to muscle ratio; RECIST; Regional hyperthermia; Skeletal muscle index; Soft tissue sarcoma; Total fat index.

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Conflict of interest statement

Declarations. Ethics approval: The study was carried out in compliance with the Declaration of Helsinki. The Internal Review Board and the Ethical Review Committee at the Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany, approved the protocol of this research project (Protocol Nr. 24–0976). Consent to participate: The need for informed consent was waived for this study by the Internal Review Board and the Ethical Review Committee at the Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany, due to its retrospective design and irreversible anonymization of all data (Protocol Nr. 24–0976). Consent for publication: Not applicable. Disclosures: All co-authors have no relevant disclosures regarding this publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of evaluated patients. Other: no RHT (n = 2), only 1 cycle of chemotherapy and RHT (n = 3), Isolated limb perfusion (n = 3), Deviation from the treatment protocol (n = 4), previous malignancy (n = 1)
Fig. 2
Fig. 2
Representative example of the performed body composition analysis. The different tissue compartments were automatically colorized and analyzed
Fig. 3
Fig. 3
Event-free survival (EFS) and overall survival (OS) according to fat to muscle ratio (FMR)
See this image and copyright information in PMC

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