Low preoperative skeletal muscle density is predictive for negative postoperative outcomes in older women with ovarian cancer

Vera van der Zanden; Neeltje J van Soolingen; Alain R Viddeleer; Johannes W Trum; Frédéric Amant; Marian J E Mourits; Johanneke E A Portielje; Frederiek van den Bos; Cornelis D de Kroon; Marjolein J Kagie; Stanley A Oei; Astrid Baalbergen; Anne-Marie L D van Haaften-de Jong; Danny Houtsma; Barbara C van Munster; Esteban T D Souwer

doi:10.1016/j.ygyno.2021.05.039

Low preoperative skeletal muscle density is predictive for negative postoperative outcomes in older women with ovarian cancer

Gynecol Oncol. 2021 Aug;162(2):360-367. doi: 10.1016/j.ygyno.2021.05.039. Epub 2021 Jun 7.

Authors

Vera van der Zanden¹, Neeltje J van Soolingen², Alain R Viddeleer³, Johannes W Trum², Frédéric Amant⁴, Marian J E Mourits⁵, Johanneke E A Portielje⁶, Frederiek van den Bos⁶, Cornelis D de Kroon⁷, Marjolein J Kagie⁸, Stanley A Oei⁹, Astrid Baalbergen¹⁰, Anne-Marie L D van Haaften-de Jong¹¹, Danny Houtsma¹², Barbara C van Munster¹³, Esteban T D Souwer⁶

Affiliations

¹ University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. Electronic address: v.van.der.zanden@umcg.nl.
² The Netherlands Cancer Institute, Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
³ University Medical Center Groningen, University of Groningen, Department of Radiology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
⁴ The Netherlands Cancer Institute, Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; KU Leuven, Department of Oncology, Herestraat 49, 3000 Leuven, Belgium.
⁵ University Medical Center Groningen, University of Groningen, Department of Gynecological Oncology, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
⁶ Leiden University Medical Center, Leiden University, Department of Medical Oncology, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
⁷ Leiden University Medical Center, Leiden University, Department of Obstetrics and Gynecology, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
⁸ Haaglanden Medical Center, Department of Obstetrics and Gynecology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
⁹ Haaglanden Medical Center, Department of Radiology, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
¹⁰ Reinier de Graaf Group, Department of Obstetrics and Gynecology, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands.
¹¹ Haga Medical Center, Department of Obstetrics and Gynecology, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands.
¹² Haga Medical Center, Department of Medical Oncology, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands.
¹³ University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands. Electronic address: b.c.van.munster@umcg.nl.

PMID: 34112514
DOI: 10.1016/j.ygyno.2021.05.039

Abstract

Objective: To determine the predictive value of lumbar skeletal muscle mass and density for postoperative outcomes in older women with advanced stage ovarian cancer.

Methods: A multicenter, retrospective cohort study was performed in women ≥ 70 years old receiving surgery for primary, advanced stage ovarian cancer. Skeletal muscle mass and density were assessed in axial CT slices on level L3. Low skeletal muscle mass was defined as skeletal muscle index < 38.50 cm²/m². Low skeletal muscle density was defined as one standard deviation below the mean (muscle attenuation < 22.55 Hounsfield Units). The primary outcome was any postoperative complication ≤ 30 days after surgery. Secondary outcomes included severe complications, infections, delirium, prolonged hospital stay, discharge destination, discontinuation of adjuvant chemotherapy and mortality.

Results: In analysis of 213 patients, preoperative low skeletal muscle density was associated with postoperative complications ≤ 30 days after surgery (Odds Ratio (OR) 2.83; 95% Confidence Interval (CI) 1.41-5.67), severe complications (OR 3.01; 95%CI 1.09-8.33), infectious complications (OR 2.79; 95%CI 1.30-5.99) and discharge to a care facility (OR 3.04; 95%CI 1.16-7.93). Preoperative low skeletal muscle mass was only associated with infectious complications (OR 2.32; 95%CI 1.09-4.92). In a multivariable model, low skeletal muscle density was of added predictive value for postoperative complications (OR 2.57; 95%CI 1.21-5.45) to the strongest existing predictor functional impairment (KATZ-ADL ≥ 2).

Conclusion: Low skeletal muscle density, as a proxy of muscle quality, is associated with poor postoperative outcomes in older patients with advanced stage ovarian cancer. These findings can contribute to postoperative risk assessment and clinical decision making.

Keywords: Complications; Computed tomography; Elderly; Ovarian cancer; Postoperative; Sarcopenia; Skeletal muscle density; Skeletal muscle mass.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Cytoreduction Surgical Procedures / adverse effects*
Female
Humans
Length of Stay
Muscle, Skeletal / diagnostic imaging
Neoplasm Staging
Ovarian Neoplasms / complications
Ovarian Neoplasms / diagnosis
Ovarian Neoplasms / surgery*
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Preoperative Period
Retrospective Studies
Risk Assessment / statistics & numerical data
Risk Factors
Sarcopenia / diagnosis
Sarcopenia / epidemiology*
Sarcopenia / etiology
Tomography, X-Ray Computed / statistics & numerical data