Prognostic significance of MRI-derived sarcopenia in patients with endometrial cancer.

OBJECTIVE

To investigate the prognostic significance of MRI-derived sarcopenia in patients with endometrial cancer (EC), and to explore its association with clinicopathological features, treatment characteristics, and survival outcomes.

METHODS

This retrospective cohort study included 289 EC patients undergoing surgical staging between 2009 and 2018. Sarcopenia was measured as the lowest quartile of the third lumbar vertebra total psoas muscle area (L3 TPMA) on preoperative MRI. Associations between sarcopenia and pathological characteristics were evaluated using Pearson's Chi-square test or Fisher's exact test for categorical variables, and independent t-tests or Mann-Whitney U tests for continuous variables. To provide a contextual reference for sarcopenia-related parameters, 289 age-matched healthy women were retrospectively selected as controls. Kaplan-Meier and multivariate Cox proportional hazards analyses were conducted to assess the impact of sarcopenia on disease-free survival (DFS) and overall survival (OS).

RESULTS

Sarcopenia was identified in 24.9% (n = 72/289) of EC patients. Uterine serosal invasion was significantly more frequent in sarcopenic patients compared to non-sarcopenic patients (60.0% vs. 23.7%, p = 0.018). Adjuvant treatments, including chemotherapy, radiotherapy, and brachytherapy, did not significantly differ by sarcopenia status. L3 TPMA was significantly lower in sarcopenic patients (642 ± 110 mm²) compared to non-sarcopenic patients (1144 ± 261 mm²) and controls (1029 ± 258 mm²) (p < 0.001). In multivariate analysis, sarcopenia remained an independent predictor of both reduced DFS (p = 0.023) and OS (p = 0.035), along with FIGO 2023 stage, chemotherapy administration, and elevated CA-125 levels.

CONCLUSION

MRI-derived sarcopenia was identified in 24.9% of patients with EC and was independently associated with unfavorable pathological characteristics and poor survival outcomes.