Purpose
To investigate the value of body composition changes measured by quantitative computer
tomography (QCT) in evaluating the prognosis of advanced epithelial ovarian cancer
(AEOC) patients who underwent primary debulking surgery (PDS) and adjuvant platinum-based
chemotherapy, and constructed a nomogram model for predicting survival in combination
with prognostic inflammation score (PIS).
Method
Fifty-seven patients with AEOC between 2012 and 2016 were retrospectively enrolled.
Pre- and post-treatment CT images were used to analyze the body composition biomarkers.
The subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), cross-sectional
area of paraspinal skeletal muscle area (PMA), skeletal muscle density (SMD), body
mineral density (BMD) were measured from two sets of CT images.
Results
In multivariate analyses, VFA gain, PMA loss, BMD loss, and PIS were independent risk
factors of overall survival (OS) (HR = 3.7, 3.0, 2.8, 1.9, respectively, all p < 0.05). Receiver operating characteristic (ROC) curves showed that the prognostic
model combining body composition changes (BCC) and PIS had the highest predictive
performance (area under the curve = 0.890). The concordance index (C-index) of the
prognostic nomogram was 0.779 (95% CI, 0.673-0.886). Decision curve analysis (DCA)
demonstrated the prognostic nomogram had a great distinguishing performance.
Conclusion
CT-based body composition analyses and PIS were associated with poor OS for AEOC patients
who underwent PDS and adjuvant platinum-based chemotherapy. The prognostic nomogram
with a combination of BCC and PIS was dependable in predicting survival for AEOC patients
during treatment.
Key Words
- Ovarian cancer
- Computed tomography
- Body composition
- Sarcopenia
- Systemic inflammation
- Prognostic nomogram
- Abbreviations: AEOC advanced epithelial ovarian cancer
- AUC area under the curve
- BCC body composition changes
- BMD bone mineral density
- CA 125 carbohydrate antigen 125
- CI confidence intervals
- C-index concordance index
- CT computer tomography
- DCA decision curve analysis
- DFS disease free survival
- FIGO federation of gynecology and obstetrics
- HE4 human epididymis protein 4
- HR hazard ratio
- PDS primary debulking surgery
- PMA area of paraspinal muscle
- PIS prognosis inflammation score
- QCT quantitative computed tomography
- ROC receiver operating characteristic
- SFA subcutaneous fat area
- SMD skeletal muscle density
- VFA visceral fat area
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ovarian cancer statistics.CA Cancer J Clin. 2018; 68: 284-296
- Ovarian cancer, Version 2.2020, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2021; 19: 191-226
- Growth of ovarian cancer xenografts causes loss of muscle and bone mass: a new model for the study of cancer cachexia.J Cachexia Sarcopenia Muscle. 2018; 9: 685-700
- The importance of body composition in explaining the overweight paradox in cancer-counterpoint.Cancer Res. 2018; 78: 1906-1912
- Sarcopenia: a time for action. An SCWD position paper.J Cachexia Sarcopenia Muscle. 2019; 10: 956-961
- The plausibility of obesity paradox in cancer-point.Cancer Res. 2018; 78: 1898-1903
- V. opportunistic evaluation of bone mineral density by PET-CT in Hodgkin lymphoma patients.Endocr Pract. 2019; 25: 869-876
- Sarcopenia is an important prognostic factor in patients with cervical cancer undergoing concurrent chemoradiotherapy.Int J Gynecol Cancer. 2018; 28: 168-175
- Body composition influences post-operative complications and 90-day and overall survival in pancreatic surgery patients.GE Port J Gastroenterol. 2020; 28: 13-25
- The role of CT-quantified body composition on longitudinal health-related quality of life in colorectal cancer patients: the Colocare study.Nutrients. 2020; 12: 1247
- Subcutaneous adiposity is an independent predictor of mortality in cancer patients.Br J Cancer. 2017; 117: 148-155
- Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study.J Cachexia Sarcopenia Muscle. 2021; (In press)https://doi.org/10.1002/jcsm.12761
- Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer.J Cachexia Sarcopenia Muscle. 2019; 4: 814-826
- Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer.J Cachexia Sarcopenia Muscle. 2018; 9: 315-325
- Prospective study evaluating changes in bone quality in premenopausal women with breast cancer undergoing adjuvant chemotherapy.Clin Breast Cancer. 2020; 20: e327-e333
- Effect of gynecological cancer and its treatment on bone mineral density and the risk of osteoporosis and osteoporotic fracture.Obstet Gynecol Sci. 2020; 63: 470-479
- Contribution of adipose tissue to development of cancer.Compr Physiol. 2017; 8: 237-282
- Risk of ovarian cancer in women with pelvic inflammatory disease: a population-based study.Lancet Oncol. 2011; 12: 900-904
- The role of systemic inflammation in cancer-associated muscle wasting and rationale for exercise as a therapeutic intervention.JCSM Clin Rep. 2018; 3: e00065
- A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care.Appl Physiol Nutr Metab. 2008; 33: 997-1006
- Measurement of skeletal muscle radiation attenuation and basis of its biological variation.Acta Physiol (Oxf). 2014; 210: 489-497
- Ovarian cancer, the revised FIGO staging system, and the role of imaging.AJR Am J Roentgenol. 2016; 206: 1351-1360
- Diagnostic accuracies of the ultrasound and magnetic resonance imaging ADNEX scoring systems for ovarian adnexal mass: systematic review and meta-analysis.Acad Radiol. 2021; 30 (Epub ahead of print. In press)
- Impact of multiparametric MRI (mMRI) on the therapeutic management of adnexal masses detected with transvaginal ultrasound (TVUS): an interdisciplinary management approach.Acad Radiol. 2020; 5 (In press)
- A novel prognostic inflammation score predicts outcomes in patients with ovarian cancer.Clin Chim Acta. 2016; 456: 163-169
ACR–SPR–SSR practice guideline for the performance of quantitative computed tomography (QCT) bone densitometry. [2014-08-12]. Available at: http://www.acr.org/∼/media/ACR/Documents/PGTS/guidelines/QCT.pdf.
- Prognostic impact of CT-quantified muscle and fat distribution before and after first-line-chemotherapy in lung cancer patients.PLoS One. 2017; 12e0169136
- Understanding the mechanisms and treatment options in cancer cachexia.Nat Rev Clin Oncol. 2013; 10: 90-99
- CT body composition of sarcopenia and sarcopenic obesity: predictors of postoperative complications and survival in patients with locally advanced esophageal adenocarcinoma.Cancers (Basel). 2021; 13: 2921
- The spectrum of malnutrition/cachexia/sarcopenia in oncology according to different cancer types and settings: a narrative review.Nutrients. 2021; 13: 1980
- Psoas muscle index at the fifth lumbar vertebra as a predictor of survival in epithelial ovarian cancers.Mol Clin Oncol. 2021; 15: 177
- The impact of body composition on treatment in ovarian cancer: a current insight.Expert Rev Clin Pharmacol. 2021; 14: 1065-1074
- Low muscularity and myosteatosis is related to the host systemic inflammatory response in patients undergoing surgery for colorectal cancer.Ann Surg. 2016; 263: 320-325
- The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery.Eur J Surg Oncol. 2017; 43: 717-724
- Characterizing microarchitectural changes at the distal radius and tibia in postmenopausal women using HR-pQCT.Osteoporos Int. 2014; 25: 2057-2066
- Bone mechanical properties and changes with osteoporosis.Injury. 2016; 47 (S11-20)
- Prostaglandins as mediators of hypercalcemia associated with certain types of cancer.N Engl J Med. 1975; 293: 1278-1283
- The relationship between computed tomography-derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer.J Cachexia Sarcopenia Muscle. 2019; 10: 111-122
- Development and validation of a prognostic model to predict the prognosis of patients who underwent chemotherapy and resection of pancreatic adenocarcinoma: a large international population-based cohort study.BMC Med. 2019; 17: 66
- The prognostic prediction value of systemic inflammation score and the development of a nomogram for patients with surgically treated breast cancer.Front Oncol. 2020; 10563731
Article Info
Publication History
Published online: December 23, 2021
Accepted:
November 13,
2021
Received in revised form:
November 7,
2021
Received:
October 1,
2021
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
