Survival implications of computed tomography-derived muscle mass changes in patients with epithelial ovarian cancer undergoing bowel surgery.

OBJECTIVE

Sarcopenia is a known adverse prognostic factor in gastrointestinal cancers undergoing bowel resection; however, its prognostic relevance in epithelial ovarian cancer remains unclear. This study aimed to evaluate the prognostic impact of computed tomography (CT)-assessed sarcopenia and longitudinal changes in body composition in patients with epithelial ovarian cancer undergoing bowel resection.

METHODS

This retrospective single-center cohort study included 217 patients with epithelial ovarian cancer who underwent bowel resection. CT-based analyses using SliceOmatic software were performed to derive quantitative metrics of muscle and fat composition. Associations between survival outcomes and CT-derived body composition parameters were analyzed at baseline and post-treatment using Kaplan-Meier and Cox regression models. Among these, 166 patients with pre- and post-treatment CT scans were further analyzed to assess the prognostic value of longitudinal changes in body composition.

RESULTS

Body composition parameters, including skeletal muscle index and visceral fat area, significantly decreased after treatment (all p ≤ .001). Sarcopenia, defined as a low skeletal muscle index (<38.5 cm2/m2), was not associated with survival outcomes at either time point. However, an increase in skeletal muscle index during treatment was significantly associated with improved overall survival (p = .019) and remained significant in the multi-variable analysis (hazard ratio 0.52, 95% confidence interval 0.31 to 0.88, p = .01).

CONCLUSIONS

A single assessment of sarcopenia did not predict survival in patients with epithelial ovarian cancer undergoing bowel resection. In contrast, an increase in skeletal muscle index during treatment was independently associated with improved overall survival, highlighting the prognostic value of serial skeletal muscle index monitoring in this population.