The impact of nutritional risk factors and sarcopenia on survival in patients treated with pelvic exenteration for recurrent gynaecological malignancy: a retrospective cohort study

• Published in: Archives of gynecology and obstetrics Vol. 305; no. 5; pp. 1343 - 1352
• Main Authors: Seebacher, Veronika, Rockall, Andrea, Nobbenhuis, Marielle, Sohaib, S. Aslam, Knogler, Thomas, Alvarez, Rosa M., Kolomainen, Desiree, Shepherd, John H., Shaw, Clare, Barton, Desmond P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2022; Springer Nature B.V
• Subjects: Carcinoma, Ovarian Epithelial - surgery; Cervical cancer; Chronic Disease; Cohort analysis; Endocrinology; Endometrial cancer; Female; Genital cancers; Genital Neoplasms, Female - complications; Genital Neoplasms, Female - surgery; Gynecologic Oncology; Gynecological cancer; Gynecology; Human Genetics; Humans; Malnutrition; Malnutrition - etiology; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - pathology; Obstetrics/Perinatology/Midwifery; Ovarian Neoplasms - surgery; Pelvic Exenteration; Retrospective Studies; Risk Factors; Sarcopenia; Sarcopenia - complications; Vulvar cancer; Cachexia; Endometrial cancer; Malnutrition; Muscle attenuation; Cervical cancer
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-021-06273-7

Purpose
The aim of the present study is to investigate the prognostic significance of nutritional risk factors and sarcopenia on the outcome of patients with recurrent gynaecological malignancies treated by pelvic exenteration.
Methods
We retrospectively evaluated muscle body composite measurements based on pre-operative CT scans, nutritional risk factors as assessed by a validated pre-operative questionnaire, and clinical–pathological parameters in 65 consecutive patients with recurrent gynaecological malignancies, excluding ovarian cancer, treated by pelvic exenteration at the Royal Marsden Hospital London. Predictive value for postoperative morbidity was investigated by logistic regression analyses. Relevant parameters were included in uni- and multivariate survival analyses.
Results
We found only (1) low muscle attenuation (MA)—an established factor for muscle depletion—and (2) moderate risk for malnutrition to be independently associated with shorter overall survival (
p
 = 
0.006
and
p
 = 
0.008
, respectively). MA was significantly lower in overweight and obese patients (
p
 = 
0.04
). Muscle body composite measurements were not predictive for post-operative morbidity.
Conclusion
The study suggests that pre-operative low MA and moderate risk for malnutrition are associated with shorter survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration. Further studies are needed to validate these findings in larger cohorts.