Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
J Natl Cancer Inst. 2024 Sep 1;116(9):1513-1524. doi: 10.1093/jnci/djae112.
The association of body composition with epithelial ovarian carcinoma (EOC) mortality is poorly understood. To date, evidence suggests that high adiposity is associated with decreased mortality (an obesity paradox), but the impact of muscle on this association has not been investigated. Herein, we define associations of muscle and adiposity joint-exposure body composition phenotypes with EOC mortality.
Body composition from 500 women in the Body Composition and Epithelial Ovarian Cancer Survival Study was dichotomized as normal or low skeletal muscle index (SMI), a proxy for sarcopenia, and high or low adiposity. Four phenotypes were classified as fit (normal SMI and low adiposity; reference; 16.2%), overweight or obese (normal SMI and high adiposity; 51.2%), sarcopenia and overweight or obese (low SMI and high adiposity; 15.6%), and sarcopenia or cachexia (low SMI and low adiposity; 17%). We used multivariable Cox models to estimate associations of each phenotype with mortality for EOC overall and high-grade serous ovarian carcinoma (HGSOC).
Overweight or obesity was associated with up to 51% and 104% increased mortality in EOC and HGSOC [Hazard Ratio (HR)] = 1.51, 95% CI = 1.05 to 2.19 and HR = 2.04, 95% CI = 1.29 to 3.21). Sarcopenia and overweight or obesity was associated with up to 66% and 67% increased mortality in EOC and HGSOC (HR = 1.66, 95% CI = 1.13 to 2.45 and HR = 1.67, 95% CI = 1.05 to 2.68). Sarcopenia or cachexia was associated with up to 73% and 109% increased mortality in EOC and HGSOC (HR = 1.73, 95% CI = 1.14 to 2.63 and HR = 2.09, 95% CI = 1.25 to 3.50).
Overweight or obesity, sarcopenia and overweight or obesity, and sarcopenia or cachexia phenotypes were each associated with increased mortality in EOC and HGSOC. Exercise and dietary interventions could be leveraged as ancillary treatment strategies for improving outcomes in the most fatal gynecological malignancy with no previously established modifiable prognostic factors.
体成分与上皮性卵巢癌（EOC）死亡率之间的关系尚未完全阐明。迄今为止，有证据表明肥胖与死亡率降低（肥胖悖论）有关，但肌肉对这种关联的影响尚未得到研究。在此，我们定义了肌肉和脂肪联合暴露的体成分表型与 EOC 死亡率之间的关联。
对来自 Body Composition and Epithelial Ovarian Cancer Survival Study 中的 500 名女性的体成分进行二分法，分为正常或低骨骼肌指数（SMI），这是肌少症的代表，以及高或低肥胖。将四种表型分为健康型（正常 SMI 和低肥胖；参考；16.2%）、超重或肥胖型（正常 SMI 和高肥胖；51.2%）、肌少症和超重或肥胖型（低 SMI 和高肥胖；15.6%）以及肌少症或恶液质型（低 SMI 和低肥胖；17%）。我们使用多变量 Cox 模型来估计每种表型与 EOC 总体和高级别浆液性卵巢癌（HGSOC）死亡率之间的关联。
超重或肥胖与 EOC 和 HGSOC 死亡率分别增加了 51%和 104%（风险比（HR）= 1.51，95%置信区间（CI）= 1.05 至 2.19 和 HR = 2.04，95%CI = 1.29 至 3.21）。肌少症和超重或肥胖与 EOC 和 HGSOC 死亡率分别增加了 66%和 67%（HR = 1.66，95%CI = 1.13 至 2.45 和 HR = 1.67，95%CI = 1.05 至 2.68）。肌少症或恶液质与 EOC 和 HGSOC 死亡率分别增加了 73%和 109%（HR = 1.73，95%CI = 1.14 至 2.63 和 HR = 2.09，95%CI = 1.25 至 3.50）。
超重或肥胖、肌少症和超重或肥胖、以及肌少症或恶液质这三种表型与 EOC 和 HGSOC 的死亡率增加均相关。运动和饮食干预可以作为辅助治疗策略，用于改善这种尚无先前确定的可改变预后因素的最致命妇科恶性肿瘤的结局。
