Low muscle mass predicts poor response to neoadjuvant chemotherapy in advanced ovarian cancer

Advanced epithelial ovarian cancer (EOC) is commonly diagnosed at late stages, and despite improvements with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), prognosis remains poor. Body composition has emerged as an important determinant of treatment outcomes. Low muscle mass (LMM), particularly in obese patients with low muscle mass (OwLMM), may combine impaired functional reserve with adverse metabolic effects. However, its role in NACT outcomes in EOC remains unclear.

In this retrospective study, 52 overweight or obese women with FIGO stage III-IV EOC treated with platinum-taxane-based NACT and IDS between 2019 and 2022 were analyzed. Skeletal muscle mass was assessed on baseline computed tomography scans at the third lumbar vertebra (L3), and the lumbar skeletal muscle index (LSMI) was calculated. Patients were classified as LMM or high muscle mass (HMM) using the cohort median cut-off. Patients with both obesity and LMM were categorized as OwLMM. Treatment response was evaluated using RECIST v1.1 criteria.

The median follow-up was 10.2 months (95% CI, 7.8-12.6). Median disease-free survival (DFS) from IDS was 19.3 months (95% CI, 8.5-30.1). OwLMM patients had lower objective response rates (46.7% vs. 62.2%, p = 0.02) and inferior disease control rates (80% vs. 100%, p = 0.03) compared with other groups. BMI or LMM alone showed no significant effect. Overall survival (OS) analysis was premature due to the short follow-up period.

Low muscle mass, especially when combined with obesity, was associated with reduced NACT response and inferior disease control in advanced EOC. As sarcopenic obesity represents a key component of frailty in older adults, our findings support muscle mass assessment as a clinically relevant biomarker that may improve risk stratification and guide individualized therapy in geriatric oncology.