Muscle Attenuation Predicted Cachexia, Poor Survival in Ovarian Cancer

Muscle attenuation assessed with preoperative CT was an independent prognostic marker in patients with epithelial ovarian cancer, according to the results of a recent study. Low muscle attenuation was linked with reduced survival in these patients, information that could be useful during individualized treatment planning, according to researcher Stefanie Aust, of the Medical University of Vienna, Austria, and colleagues.

“The measurement of muscle attenuation on routine pre-operative CT is easy to perform, reproducible, ready available, and cheap,” the researchers wrote in PLoS One. “Our results showed impaired overall survival and unfavorable surgical outcome in patients with epithelial ovarian cancer and low muscle attenuation in a multivariate survival analysis, highlighting the importance of this easy-accessible marker.”

According to the study, tumor cachexia, a prognostic marker in epithelial ovarian cancer, is characterized by metabolic and inflammatory disturbances. Specifically, loss of skeletal muscle mass is considered to be indicative of the wasting process seen with changes in metabolic pathways in patients with cancer. Research has shown that preoperative CT scans are able to obtain certain body composition measurements (BCMs) including whole body skeletal mass measured using the mean muscle attenuation and skeletal muscle index (SMI) in an abdominal cross-sectional CT.

In this study, Aust and colleagues sought to determine the prognostic value of BCMs using pre-operative CT scans in patients with ovarian cancer. They enrolled 140 consecutive patients with epithelial ovarian cancer between 2004 and 2012, and evaluated muscle BCMs and other markers of nutritional and inflammatory status.

According to a multivariate analysis, muscle attention was an independent prognostic marker of survival in this patient population (hazard ratio [HR], 2.25; P = .028). Results showed that the majority of patients with low muscle attenuation had residual tumor after surgery; whereas, the majority of patients with high muscle attenuation were able to achieve optimal cytoreduction with surgery (P = .046).

“The presence of any post-operative residual tumor is a powerful factor with a tremendous impact on overall survival,” the researchers wrote. “Thus, CT scan analysis might help to identify those patients, in whom optimal cytoreduction is unlikely to be achieved.”

Normal weight and underweight patients had a higher muscle attenuation compared with overweight and obese patients, underlying that “BMI alone is a relatively inaccurate measurement of muscle composition and cancer cachexia in epithelial ovarian cancer,” the researchers wrote.

A reduced SMI had no effect on survival in these patients.

As part of the study the researchers also evaluated an inflammatory marker panel that included 25 cytokines, including the pro-cachectic cytokines TNFα, IL-6, IL-1, and IFN-y as well as anti-cachectic cytokines such as IL-10, IL-4, IL-13, and IL-1RA to determine if there was a relationship between BCMs, inflammatory markers, and patient outcomes. Using multivariate linear regression analysis, they found that eotaxin (P = .021) and IL-10 (P = .047) were independent predictor of muscle attenuation.