Rutten I J G, Ubachs J, Kruitwagen R F P M, van Dijk D P J, Beets-Tan R G H, Massuger L F A G, Olde Damink S W M, Van Gorp T
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.
Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Eur J Surg Oncol. 2017 Apr;43(4):717-724. doi: 10.1016/j.ejso.2016.12.016. Epub 2017 Jan 19.
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).
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 cm/m). 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.
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.
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.
肌肉减少症，即严重的骨骼肌流失，已被确定为多种恶性肿瘤的预后因素。本研究旨在调查肌肉减少症是否与接受初次肿瘤细胞减灭术（PDS）的晚期卵巢癌患者的总生存期（OS）及手术并发症相关。
回顾性纳入接受PDS治疗的卵巢癌患者（n = 216）。在第三腰椎水平的轴向计算机断层扫描上测量总骨骼肌表面积。采用最佳分层法确定定义肌肉减少症的最佳骨骼肌指数临界值（≤38.73 cm/m）。采用Cox回归和Kaplan-Meier分析来分析肌肉减少症与OS之间的关系。通过逻辑回归研究肌肉减少症对主要手术并发症发生情况的影响。
Kaplan-Meier分析显示，与无肌肉减少症的患者相比，有肌肉减少症的患者存在显著的生存劣势（p = 0.010）。肌肉减少症单因素预测OS（风险比1.536（95%置信区间1.105 - 2.134），p = 0.011），但在多变量Cox回归分析中不显著（风险比1.362（95%置信区间0.968 - 1.916），p = 0.076）。多变量Cox回归分析中OS的显著预测因素为完全肿瘤细胞减灭术、在专科中心接受治疗以及发生主要并发症。肌肉减少症不能预测主要并发症。
肌肉减少症不能预测接受初次肿瘤细胞减灭术的卵巢癌患者的OS或主要并发症。然而，观察到有肌肉减少症的患者存在生存劣势的强烈趋势。未来的前瞻性研究应聚焦于预防或逆转肌肉减少症以及可能提高卵巢癌生存率的干预措施。完全肿瘤细胞减灭术仍然是卵巢癌生存的最强预测因素。
