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Extreme leanness, lower skeletal muscle quality, and loss of muscle mass during treatment are predictors of poor prognosis in cervical cancer treated with concurrent chemoradiation therapy

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Abstract

Background

Human papillomavirus vaccination is not widespread in Japan, and the low screening rates result in many cases of locally advanced cervical cancer. We investigated the prognostic significance of sarcopenia in patients with cervical cancer to guide healthcare policies to improve treatment outcomes.

Methods

This retrospective study included 83 patients with cervical cancer without distant metastasis who underwent primary concurrent chemoradiotherapy between 2013 and 2018. We analyzed the indicators of physical condition and muscle quantity using the SYNAPSE VINCENT software. Muscle mass and the relationship between treatment toxicity and prognosis were evaluated.

Results

The patients’ median age was 60 (range 33‒80) years. Cancer stage distribution was as follows: cT2b or higher, 84.3%; N1, 65.1%; and MA, 27.7%. The overall sarcopenia (skeletal muscle index [SMI] < 38.5) rate was 30.1%, and the rate was 33.9 and 22.2% in patients aged < 64 and ≥ 65 years, respectively. No correlation was observed between clinical stage and musculoskeletal indices. Treatment resulted in decreased body weight and SMI; after treatment, the sarcopenia rate increased to 37.3%. A higher intramuscular adipose tissue content (IMAC) reduced the number of chemotherapy cycles needed. Treatment-associated SMI decreases of ≥ 7% indicated poor prognosis, with significant differences in progression-free survival and overall survival (p = 0.013 and p = 0.012, respectively). Patients who were very lean (body mass index < 18.5 kg/m2) before treatment had a poor prognosis (p = 0.016 and p < 0.001).

Conclusions

Our findings emphasize the importance of assessing original nutritional status and maintaining muscle mass and quality during the treatment of patients with cervical cancer.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We wish to appreciate M Yuasa for providing support in the body composition analysis of the computed tomography images of the patients examined in this study.

Funding

This research received no specific funding from any agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Gynecology, Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Akiko Abe

  2. Department of Obstetrics and Gynecology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Akiko Abe, Tomohiro Kagawa, Ayuka Mineda, Masato Nishimura & Takeshi Iwasa

  3. Department of Radiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Masao Yuasa

  4. Department of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Yoshie Imai

  5. Department of Radiology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Chisato Tonoiso, Akiko Kubo & Takashi Kawanaka

  6. Department of Therapeutic Radiology, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Hitoshi Ikushima

Authors
  1. Akiko Abe
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  2. Masao Yuasa
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AA and MY. The first draft of the manuscript was written by AA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Akiko Abe.

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Abe, A., Yuasa, M., Imai, Y. et al. Extreme leanness, lower skeletal muscle quality, and loss of muscle mass during treatment are predictors of poor prognosis in cervical cancer treated with concurrent chemoradiation therapy. Int J Clin Oncol 27, 983–991 (2022). https://doi.org/10.1007/s10147-022-02140-w

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  • DOI: https://doi.org/10.1007/s10147-022-02140-w

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