Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis
In this study, a meta-analysis was carried out to determine the correlation between low skeletal muscle index (SMI) and the clinicopathological features and prognosis of patients with ovarian cancer.
Advances in the ability to predict the overall survival rate and prognosis of ovarian cancer would be beneficial in order to counsel patients better and manage their care.
Ovarian cancer simply put, is a malignant disease of the ovary. It is also one of the leading causes of mortality in females. Its high mortality rate is recorded in the United States as the commonest cause of death among women with gynecological tumors. This is because there are inadequate screening modalities, vague presenting symptoms, and as a result, patients present late with more advanced disease.
Skeletal muscle index (SMI) is a measure of the whole body muscle mass. It is estimated using computed tomography (CT) scans best at the third lumbar spine. Several studies have previously suggested a correlation between skeletal muscle index and the disease progression of several malignancies. These studies were based on the premise that certain malignancies in their more advanced stage result in a progressive loss of muscle mass and function, also known as sarcopenia.
With this in mind, the primary objective of this study was to determine the correlation between low skeletal muscle index and the clinicopathologic features and prognosis of patients with ovarian cancer.
Sarcopenia is a medical condition involving a progressive loss of muscle mass and functionality. Here, there is progressive muscle atrophy. Sarcopenia occurs physiologically in the elderly people as part of the aging process. It is also a consistent clinical feature of cancer malnutrition, which is seen in cancer patients with advanced stage disease. A 38.6% incidence of sarcopenia was recorded amongst 6894 cancer patients in a study review involving 35 articles.
Skeletal Muscle Index
Skeletal muscle index is used to quantify the mass and functionality of the muscle fibers. In other words, it assesses the skeletal muscle mass and confirms or rules out sarcopenia. It is measured via computed tomographic imaging (CT-scan) of the muscle, preferably over the lower L3 segment. The aim of this study was to analyze the correlation between the skeletal muscle index and the ovarian cancer disease progression.
This meta-analysis utilized a systematic literature search using three databases, which are PubMed, EMBASE and Cochrane, and was conducted on June 10, 2022. Certain keywords were used to aid in the search, and they include: skeletal muscle, ovarian cancer, ovarian malignancy, ovarian tumor and cachexia.
This literature review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).
This meta-analysis is registered with the PROSPERO International Prospective Register of Systematic Reviews, CRD42022369501.
The analysis included studies written in English language, involving humans with ovarian cancer who were receiving treatment. These studies must have also demonstrated sarcopenia using skeletal muscle index with overall survival rate or chemotherapy-related toxicity as the reported outcomes.
Studies using computed tomography (CT) studies of the psoas muscle only, and studies that were review articles, conference abstracts or case reports were excluded. In addition, studies involving cohorts of less than five patients, or with incomplete or insufficient data were excluded.
This analysis was limited to studies with skeletal muscle index measurements of the total skeletal muscle area including the erector spinae, the psoas, quadratus lumborum, etc. Due to the wide cutoff for assessing sarcopenia from SMI, its prevalence amongst the patients in this study had a wide range of 11.4% to 63.7%.
Study Quality Assessment
Methodological quality assessment was carried out using the Newcastle-Ottawa Scale (NOS). Here, high-quality studies have a score of 7 and above, a moderate quality study scoring between 5 and 7, and a low-quality study scoring less than 5. This scoring system was based on patient selection, study comparability and endpoint.
- 1286 studies resulted from the comprehensive literature search medical databases.
- 81 full-text articles were considered for use this analysis based on inclusion criteria.
- 68 studies were screened out based on the exclusion criteria, leaving 13 studies to be used for this analysis.
- The 13 studies included were published between 2015 and 2022.
- The included studies had a sample size ranging from 69 to 323 women, with a total of 1814 patients.
- Patients had a mean age range of 54.5 ± 10.5 to 66.5 ± 0.8 years, and mean body mass index (BMI) ranging from 22.3 ± 3.3 to 25.9 ± 0.5 kg/m².
- All patients in the included studies have had tumor debulking surgery, alongside adjuvant or neoadjuvant chemotherapy.
- The included studies involved SMI measurements at L3 and osteopenia which was demonstrated with a cutoff of 38.5 to 41.5 cm²/m².
The correlation between Low Skeletal Muscle Index and Body Mass Index
5 of the 13 studies assessed the correlation between low SMI and BMI.
Patients were divided into two categories; those with low SMI and those with high SMI.
Each of these groups were further divided into two based on their BMI; those with BMI less than 25 kg/m² and those with BMI greater than 25 kg/m².
Based on these studies, there was a clinically significant correlation between SMI levels and BMI values in these patients. It was demonstrated that patients with low SMI usually had lower BMI values (P<0.00001 with an OR:5.08 and 95% CI:3.54–7.30).
The correlation between Low Skeletal Muscle Index and Clinicopathological Features
Studies were reviewed to analyze the relationship between low SMI and the clinicopathological features of ovarian cancer.
The features assessed included:
- The FIGO stage of the tumor
- The histopathologic type of the tumor
- The histopathological tumor grade
- Intraoperative R0 cell reduction
It was noted that 127 patients were in stage I-II, while 638 patients were in stage III-IV cancer.
These studies demonstrated a correlation between SMI and clinicopathological features.
Low SMI was associated with advanced cancer stage, and as such, patients were less likely to achieve R0 cytoreduction.
6 included studies analyzed R0 cytoreduction in patients with low SMI, and showed that a slightly higher number with low SMI could not achieve R0 cytoreduction.
Pathological grade of the tumor was seen to have no correlation with low SMI as demonstrated in 6 studies.
Histopathologic types of ovarian cancer were also shown to have no correlation with low SMI as demonstrated in 5 studies.
The correlation between Low Skeletal Muscle Index and Chemotherapy-related Toxicity
In analysis involving 3 studies, it was demonstrated that chemotherapy-related toxicity had no correlation with low SMI in patients with ovarian cancer.
The correlation between Low Skeletal Muscle Index and Progression-Free Survival (PFS)
An analysis of 3 studies involving 424 patients showed a strong correlation between low SMI and PFS.
The correlation between Low Skeletal Muscle Index and Overall Survival (OS)
An analysis of 8 studies involving 1356 patients demonstrated that a low SMI reduced the 5-year survival rate of patients with ovarian cancer. Thus, there is a strong correlation between low SMI and lower 5-year OS rate.
This analysis was aimed at demonstrating the correlation between CT-assessed skeletal muscle index and the clinical features and prognosis of patients with ovarian cancer.
Evidence obtained from a total of 13 studies showed that sarcopenia defined by low SMI was associated with lower PFS and OS, as well as low BMI, advanced FIGO stage and less R0 cytoreduction.
Women with low BMI, advanced FIGO stage and less R0 cytoreduction usually had poor nutritional intake and extensive disease which usually lead to sarcopenia.
This analysis suggested that CT-assessed sarcopenia at L3 was common among women with ovarian cancer, especially those with more advanced cancer stage.
It was demonstrated in this study that a low SMI is not only associated with decreased progression-free survival and overall survival, but also a decreased BMI, more advanced FIGO stage and reduced ability to achieve R0 cytoreduction. These factors lead to a poorer prognosis in patients with ovarian cancer.
Oncology Related Tools
- Prognostic Scoring for Myelofibrosis
- Opioid Conversion Calculator
- Updated Advanced Opioid Conversion Calculator
- Nonsteroidal anti-inflammatory drugs (NSAID) Selection Tool
- Absolute Neutrophil Count Calculator
- Body Surface Area (BSA) Multi-Calc
- Carboplatin AUC Calculator
- Carboplatin AUC – Updated Version
- Urinary Indices, Renal Failure Index (RFI) and Fractional Excretion of Sodium (FE-NA)
- Creatinine Clearance (CRCL) – Standard Calculator
- Creatinine Clearance Multi-Calc – All of the latest research
- Patient Controlled Analgesia (PCA) Settings
- Intravenous Antineoplastic Agents – Administration Guidelines
- Therapeutic Drug Levels
- Beers Criteria for potentially inappropriate medications
- Allergic response? 12-step desensitization protocol
- Protein requirements calculator
- Basal Metabolic Rate (BMR) Multi-calc (Estimate caloric requirements)
- Irritable Bowel Syndrome Treatment Options
- Common Anti-emetics
- Fall Assessment – Berg Balance Scale
- Diabetes Mellitus During The Pandemic
- Carfilzomib Therapy In Pediatric Acute Lymphoblastic Leukemia
- Golimumab Compliance In Long-Term Arthritis Treatment
- Medullary Thyroid Cancer And Vocal Cord Paralysis
- Primary Adenocarcinoma Of The Orbit: A Case Study
- Survival Trends: Pancreatic Cancer in the USA
- Nusinersen Therapy For Pediatric Spinal Muscular Atrophy
- Pediatric Liver Transplantation: A New Biological Abdominal Wall
- Influenza Surveillance: A Review Of Data Sources
- Remission of Renal Cell Carcinoma With Brain Metastases: A Case Study
- Dry Eye Disease And Dehydration
- Macular Edema Therapy Using Dexamethasone Nanoparticle Suspension
- Colorectal Cancer Screening For Older Adults
- Satiation And Satiety: An Overview And Clinical Calculator
- Cholesterol Screening To Aid In Glaucoma Detection
- Hearing Screening After Chemotherapy: A Study On Childhood Cancer Survivors
- Olfactory Dysfunction and Screening For Depression: A QOL Study
- Cancer Diagnosis And Mental Health
- Mental Health Screening In Psoriatic Arthritis Patients
- Prostate Cancer: A New Biopsy Risk Calculator Using MRI
- Mental Health Study in Cancer Survivors
- Mental Health Screening In The Community
- Bone Mineral Density Screening Combined With Mammography
- Bone Mineral Density In Type 1 Diabetes Mellitus
- Cochlear Implants and Vestibular Screening
- Aprocitentan In Resistant Hypertension
- Predicting Cardiovascular Disease With Body Mass Index
- Obesity Screening To Predict Hot Flashes
- Hypertension Screening For Cardiovascular Health
- Dental Screening For Cardiovascular Disease Risk
- Blood Pressure and CVD Risk Reduction
- Lifestyle Changes For Hypoglycemia Prevention
- Ovarian Adenocarcinoma With Glaucoma: A Case Report
- Community Hypertension and Atherosclerosis Risk
- Thyroid Malignancy and Serum Calcitonin
- Rare Schwannoma In Lateral Nasal Wall
- Pyrotinib Therapy In HER2+ Breast Cancer
- Osteopenia Predicts Outcomes in Pancreatic Cancer
- Outcomes of Physical Exercise Regimens in Advanced Cancer
- Penile Squamous Cell Carcinoma And HPV
- Radiation Therapy And VTE Risk
- Pseudouveitis With Pancreatic Carcinoma: A Case Study
- Cancer Prevention In Rural Communities
- Skeletal Muscle Mass and Cancer Patient Quality of Life: A Meta-Analysis
- Incidence of Secondary Cancers After CIRT VS RT
- Filanesib Combination Therapy in Multiple Myeloma
- Pediatric Leukemia Patients Utilizing Levofloxacin
- Breast Cancer And An Analysis Of Cardiovascular Events
- Monotherapy Or Chemotherapy Adjunct: Pembrolizumab in Advanced NSCLC
- Advanced Gastric Cancer: Prognosis with Nivolumab Monotherapy
- Sinonasal B‐Cell Lymphomas A Cohort Study On Progression And Recurrence
- Platinum Resistant Recurrent Ovarian Cancer Treatment+/-Bevacizumab
- Metastatic Melanoma and Follow-Up MRI Scans
- Isatuximab Treatment in Refractory T-Acute Lymphoblastic Leukemia
- Ocular Melanoma and Treatment with Metformin
- Gastric Neuroendocrine Neoplasms
- Lung Cancer with Brain Metastasis After Late-Onset Bipolar Disorder: A Case Report
- Anlotinib with Camrelizumab in Lung Cancer Treatment
- Sebaceous Carcinoma Treatment Outcomes: A Multicenter Study
- Diffuse-Type Tenosynovial Giant Cell Tumors: Treatment and Progression
- Lung Spindle Cell Carcinoma Responsive to Pembrolizumab: A Rare Case Report
- DNA Methylation Profiling in Sarcoma Classification
- Breast Tomosynthesis Simulator For Virtual Clinical Trials
- Renal Cell Carcinoma-Prognosis Via Albumin Levels
- Diagnostic Error Causing Cases of Cytopenia
- Hodgkin’s Lymphoma: A Case Study With Nystagmus and Diplopia
- Brugada Syndrome Treated with Lenalidomide: A Case Study
- Koolen-de Vries Case Study
- Suicidal Ideation and Somatic Treatments
- Study on Pavlovian Fear Conditioning and Fear Reversal in OCD
- Anxiety Scales in Lewy Body Disease
- Inoperable Locally Advanced Non-Small Cell Lung Cancer: Survival Rates of Endostar, CCRT
- Physician Practice Management and Private Equity
- Physician Spending And Its Association With Patient Outcomes
- Physician Burnout: Causes and Prevention
- LEAP-MS: Adaptations for Advanced Stages
- MS: Exercise Impacts on MRI
- The Role of Preretirement Job Complexity in Cognitive Performance
- Extrapontine Myelinolysis and PTA in Pregnancy
- Verbal Communication and Masks
- Sugammadex Versus Neostigmine in Thyroidectomy
- SGLT Inhibitors on Weight and Lipid Metabolism in Diabetes
- Saxagliptin: Obese Patients with Impaired Glucose Tolerance
- Levothyroxine Therapy and Depression
- Grave’s Disease and Risk of Systemic Lupus Erythematosus
- Benign Thyroid Removal and Patient Satisfaction
- MF- Biology, Management, and a Case Study of Ocular Manifestation
- Quality Of Life In Adolescent Cancer Survivors
- Cancer Opioid Risk Score
- Oncology-Specific Opioid Risk Calculator In Cancer Survivors
- 3D MRI for Non-invasive Ocular Proton Therapy of Uveal Melanomas
- Sexual Dysfunction in Prostate Cancer Patients
- 3-Day Surprise Question To Predict Survival Rates in Advanced Cancer Patients