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Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis
  1. Emanuele Rinninella1,2,
  2. Anna Fagotti3,4,
  3. Marco Cintoni5,
  4. Pauline Raoul6,
  5. Giuseppe Scaletta7,
  6. Giovanni Scambia4,7,
  7. Antonio Gasbarrini8,9 and
  8. Maria Cristina Mele9,10
  1. 1 Clinical Nutrition Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2 Research and Training Center in Human Nutrition, Università Cattolica del Sacro Cuore, Rome, Italy
  3. 3 Ovarian Cancer Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4 Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5 Scuola di Specializzazione in Scienza dell'Alimentazione, University of Rome Tor Vergata, Rome, Italy
  6. 6 Advanced Nutrition in Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
  7. 7 Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
  8. 8 Internal Medicine and Gastroenterology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
  9. 9 Dipartimento di Medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
  10. 10 Advanced Nutrition in Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Italy
  1. Correspondence to Dr Emanuele Rinninella, Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy; emanuele.rinninella{at}unicatt.it

Abstract

Background Muscle mass plays a key role in predicting clinical outcomes in cancer. This systematic review and meta-analysis aimed to evaluate whether computed tomography (CT) scan indexes of muscle mass quantity and quality could be used as prognostic factors in ovarian cancer.

Methods Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search from inception to January 2020. The primary outcome was overall survival. Pooled analyses of hazard ratios (HRs) and 95% confidence intervals (CIs) were performed with Review Manager 5.3. Heterogeneity was assessed by measuring inconsistency (I2 based on the χ2 test). Secondary outcomes included progression free survival, disease free survival, postoperative complications, and chemotoxicity. Study quality and quality of evidence were assessed.

Results A total of 15 studies were included in the systematic review, of which six studies (1226 patients) were included in the meta-analysis. Summary unadjusted HRs (HR 1.11, 95% CI 0.84 to 1.46, p=0.47) and adjusted HRs (HR 1.10, 95% CI 0.84 to 1.43, p=0.49) did not show a significant association between low skeletal muscle index and overall survival (p>0.05) in ovarian cancer. Instead, although the quality of evidence was low, pooled data of three studies, comprising 679 patients, showed a significant association between low skeletal muscle radiodensity and poor overall survival (HR 1.63, 95% CI 1.28 to 2.07, p<0.0001). Moreover, the heterogeneity between studies precluded the possibility of performing a meta-analysis and reaching conclusions for progression free survival, disease free survival, surgical complications, and chemotoxicity.

Conclusions This work suggested that the measurement of skeletal muscle radiodensity by routine CT scan at diagnosis, with standardization of diagnostic criteria, could be a reliable tool to select at risk patients and to individualize effective nutritional strategies. However, prospective homogeneous studies with a larger number of patients are required to confirm these results.

  • ovarian cancer
  • psoas muscles
  • postoperative care
  • preoperative care
  • postoperative complications
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Footnotes

  • Twitter @annafagottimd

  • Contributors ER conceived the topic and revised the manuscript. MC, GiuS, and PR selected bibliographic sources. PR prepared the manuscript and generated the schematic diagrams. AG and GioS revised the final version. AF and MCM coordinated the working group and revised the final version. All authors made significant contributions to this review article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Not applicable.

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