Pretreatment CT-defined sarcopenia is associated with worse survival in cervical cancer

To evaluate the prevalence and prognostic relevance of pretreatment computed tomography-defined sarcopenia in women with cervical cancer treated with definitive radiotherapy with or without concurrent chemotherapy.

This retrospective cohort study included women aged 18 years or older with FIGO 2018 stage IB2 to IVA cervical cancer who initiated definitive radiotherapy, with or without radiosensitizing chemotherapy, between January 2016 and December 2018 at CAISM/UNICAMP, Campinas, Brazil. Follow-up continued through 2022 to ensure a minimum follow-up period to evaluate 5-year survival outcomes. Women with prior malignancy treated with chemotherapy or radiotherapy, unavailable or non-measurable pretreatment computed tomography, pregnancy, or death before treatment initiation were excluded. Pretreatment sarcopenia was defined as skeletal muscle index <38.9 cm²/m² using bilateral psoas and paraspinal linear measurements at L3 on planning computed tomography. Treatment response followed World Health Organization response definitions. Progression-free survival and overall survival were estimated using Kaplan-Meier methods and compared with log-rank tests. Cox proportional hazards models and multivariable logistic regression were performed to estimate hazard ratios (HR), odds ratios (OR), and 95% confidence intervals.

Among 210 included women, 79 (37.6%) had pretreatment sarcopenia. Most patients had squamous histology (176/210, 83.8%), advanced FIGO stage III/IV disease (120/210, 57.1%), and received chemotherapy (177/210, 84.3%). Sarcopenia was more frequent among women aged <50 years, premenopausal women, women with body mass index <25 kg/m², and women with anemia. Complete or stable response occurred in 100 patients, whereas progression or recurrence occurred in 110; sarcopenia was more common among patients with progression or recurrence. In univariable analysis, pretreatment sarcopenia was associated with worse progression-free survival (HR 1.70, 95% CI 1.15 to 2.51) and overall survival (HR 1.75, 95% CI 1.11 to 2.75). In multivariable Cox regression, complete response to treatment was the only factor independently associated with overall survival (HR 0.07, 95% CI 0.02 to 0.18, p < 0.0001). Multivariable logistic regression showed a trend for higher sarcopenia prevalence in women aged <50 years (OR 1.73, 95% CI 0.98 to 3.05, p = 0.057).

Pretreatment CT-defined sarcopenia was common and associated with poorer survival outcomes in univariable analysis, although treatment response remained the strongest independent prognostic factor in women with cervical cancer treated with definitive chemoradiotherapy.