Investigating the Prognostic Value of Pretreatment Body Composition in Women with Ovarian Cancer: Impact on Clinical Outcomes

In ovarian cancer, the association between low muscle mass and outcomes is unclear, despite well-established evidence in other cancer diagnoses. Overall body composition may have greater prognostic value. This study aimed to investigate associations between body composition and clinical outcomes.

Retrospective study of women diagnosed with ovarian cancer between August 2020 and March 2024. Clinical characteristics were extracted from medical records. Body composition phenotypes (low skeletal muscle index [SMI], low skeletal muscle density [SMD], high subcutaneous [SATI], visceral [VATI] and total adipose tissue index [TATI]) were assessed from pre-treatment CT images. Logistic regression, chi-squared, Fisher's exact tests, and Mann-Whitney U tests were used to assess associations between body composition phenotypes, patient characteristics and study outcomes. Cox proportional hazards models were fitted to examine associations with survival.

Ninety-nine patients [mean (SD) age 61 (12.7) years, 80% stage III/IV] were included. Overall, 67 (67%) women had low SMI, 57 (57%) low SMD, and 49 (49%) high TATI. Thirty-seven (37%) women had low SMI and low SMD, 23 (23%) low SMI with high TATI, and 33 (33%) low SMD with high TATI. Post-menopausal status was associated with higher VAT (p = 0.004). Low SMI or low SMD co-occurring with high adiposity was associated with a 1.91-2.03 and 2.15-2.49 higher hazard mortality. There was insufficient or weak evidence of an association between body composition and other treatment outcomes.

These findings suggest additive effects when phenotypes co-occur. In ovarian cancer, singular assessments may be an oversimplification. Future studies should continue to consider co-occurring phenotypes to adequately capture risk.