BACKGROUND Sarcopenia is commonly observed in patients with advanced-stage epithelial ovarian cancer (EOC). However, the effect of body composition changes-during primary debulking surgery (PDS) and adjuvant platinum-based chemotherapy-on outcomes of patients with advanced-stage EOC is unknown. This study aimed to evaluate the association between body composition changes and outcomes of patients with stage III EOC treated with PDS and adjuvant platinum-based chemotherapy. METHODS Pre-treatment and post-treatment computed tomography (CT) images of 139 patients with stage III EOC were analysed. All CT images were contrast-enhanced scans and were acquired according to a standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured using CT images obtained at the L3 vertebral level. Predictors of overall survival were identified using Cox regression models. RESULTS The median follow-up was 37.9 months. The median duration between pre-treatment and post-treatment CT was 182 days (interquartile range: 161-225 days). Patients experienced an average SMI loss of 1.8%/180 days (95% confidence interval: -3.1 to -0.4; P = 0.01) and SMD loss of 1.7%/180 days (95% confidence interval: -3.3 to -0.03; P = 0.046). SMI and SMD changes were weakly correlated with body mass index changes (Spearman ρ for SMI, 0.15, P = 0.07; ρ for SMD, 0.02, P = 0.82). The modified Glasgow prognostic score was associated with SMI loss (odds ratio: 2.42, 95% confidence interval: 1.03-5.69; P = 0.04). The median time to disease recurrence was significantly shorter in patients with SMI loss ≥5% after treatment than in those with SMI loss <5% or gain (5.4 vs. 11.2 months, P = 0.01). Pre-treatment SMI (1 cm2 /m2 decrease; hazard ratio: 1.08, 95% confidence interval: 1.03-1.11; P = 0.002) and SMI change (1%/180 days decrease; hazard ratio: 1.04, 95% confidence interval: 1.01-1.08; P = 0.002) were independently associated with poorer overall survival. SMD, body mass index, and total adipose tissue index at baseline and changes were not associated with overall survival. CONCLUSIONS Skeletal muscle index decreased significantly during treatment and was independently associated with poor overall survival in patients with stage III EOC treated with PDS and adjuvant platinum-based chemotherapy. The modified Glasgow prognostic score might be a predictor of SMI loss during treatment.

中文翻译：

---

初次减重手术和化学疗法期间的肌肉丢失预示着晚期卵巢癌的生存率较低。

背景技术肌肉减少症通常在晚期上皮性卵巢癌（EOC）患者中观察到。然而，尚不清楚在初次减重手术（PDS）和基于铂的辅助化疗期间，机体组成变化对晚期EOC患者预后的影响。这项研究旨在评估PDS和辅助性铂类化学疗法治疗的III期EOC患者的身体成分变化与结局之间的关联。方法分析139例III期EOC患者的治疗前和治疗后计算机断层扫描（CT）图像。所有CT图像均为对比增强扫描，并根据标准化协议获取。骨骼肌指数（SMI），骨骼肌放射密度（SMD），使用在L3椎骨水平获得的CT图像测量总脂肪组织指数。使用Cox回归模型确定整体生存的预测指标。结果中位随访时间为37.9个月。治疗前和治疗后CT之间的中位时间为182天（四分位间距：161-225天）。患者的平均SMI丧失为1.8％/ 180天（95％置信区间：-3.1至-0.4; P = 0.01）和SMD丧失为1.7％/ 180天（95％置信区间：-3.3至-0.03; P = 0.046）。SMI和SMD变化与体重指数变化呈弱相关性（SMI的Spearmanρ为0.15，P = 0.07； SMD的ρearmanρ为0.02，P = 0.82）。改良的格拉斯哥预后评分与SMI丢失相关（赔率：2.42，95％置信区间：1.03-5.69； P = 0.04）。SMI丢失≥5％的患者在治疗后疾病复发的中位时间明显少于SMI丢失<5％或增加的患者（5.4 vs. 11.2个月，P = 0.01）。预处理SMI（减少1 cm2 / m2;危险比：1.08，95％置信区间：1.03-1.11; P = 0.002）和SMI变化（减少1％/ 180天;危险比：1.04，95％置信区间： 1.01-1.08; P = 0.002）与较差的总体生存率独立相关。基线时的SMD，体重指数和总脂肪组织指数及其变化与总体生存率无关。结论在PDS和辅助性铂类化学疗法治疗的III期EOC患者中，治疗期间骨骼肌指数显着下降，并且与总体生存期差有关。