Prevalence of ovarian cancer cachexia in patients undergoing cytoreductive surgery at the University of Colorado between 2014-2024.

BACKGROUND

Cancer cachexia is an underrecognized condition characterized by weight loss and muscle wasting resulting from altered metabolism and systemic inflammation. While this comorbid condition is associated with surgical complications and poorer prognosis in other cancer types, its prevalence in epithelial ovarian cancer is not well described. We evaluated the prevalence of cachexia in patients with epithelial ovarian cancer and clinical characteristics associated with cachexia.

METHODS

A retrospective cohort study with longitudinal follow up was performed on 374 patients who underwent cytoreductive surgery for epithelial ovarian cancer. Adult patients, without risk factors for sarcopenia, who underwent surgery from January 2014-June 2024 were evaluated for preoperative weight, skeletal muscle index, demographics, physical and tumor characteristics, oncologic treatment, and outcomes with cancer cachexia.

RESULTS

Cancer cachexia was common (> 50% of cohort) and more frequently observed in patients who had interval cytoreductive surgery (odds ratio [OR] 3.34, 95% CI 2.16–5.06), required preoperative paracentesis or thoracentesis (OR 4.45, 95% CI 2.73–7.28), had advanced-stage disease (OR 3.76, 95% CI 2.17–6.57), serous histology (OR 1.87, 95% CI 1.12–3.11), and aberrant p53 expression (OR 1.77, 95% CI 1.11–2.78). Median Cancer Antigen 125 (CA-125) was higher in the population of patients with cachexia than among those without (p < 0.0001), though discriminatory performance was modest. Cachexia was associated with shorter disease-free survival and overall survival. Median disease-free survival was 19.8 months in patients with cachexia compared with 42.0 months in those without (log-rank p < 0.0001). Median overall survival was 51.2 months versus 72.0 months, respectively (log-rank p = 0.02).

CONCLUSIONS

Over half of patients with epithelial ovarian cancer will have cachexia at the time of cytoreductive surgery. Risk factors for cachexia include interval cytoreductive surgery, need for paracentesis, advanced stage, serous histology, and aberrant p53 expression. Disease-free survival and overall survival are worse in patients with cachexia compared to those without.