Objectives To investigate the impact of sarcopenia and body composition on survival outcomes in patients with early-stage cervical cancer.

Methods We retrospectively analyzed patients diagnosed with 2009 FIGO stage IB1-IIA2 cervical cancer who underwent primary radical hysterectomy between 2007 and 2019. Using an artificial intelligence-based tool, the skeletal muscle area (cm²) at the third lumbar vertebra (L3) and the skeletal muscle volume (cm³) at the waist level were measured from pre-treatment CT scans. These were converted to the L3 and volumetric skeletal muscle indices (SMIs) by normalization. We defined L3 and volumetric sarcopenia using 39.0 cm²/m² and the first quartile value, respectively. Patients’ survival outcomes were compared according to the presence of sarcopenia.

Results A total of 306 patients were included. Between the L3 sarcopenia and non-sarcopenia groups, no differences in progression-free survival (PFS) and overall survival (OS) were observed. In contrast, the volumetric sarcopenia (n=76) showed significantly worse PFS (P=0.039) and OS (P=0.031) than did the volumetric non-sarcopenia group (n=230). In multivariate analyses, volumetric sarcopenia was identified as a poor prognostic factor for PFS (aHR, 1.872; 95% CI, 1.026–3.415; P=0.041) and OS (aHR, 3.172; 95% CI, 1.058–9.512; P=0.039). Regarding changes in body composition, initial volumetric sarcopenia with total fat gain during primary treatment was associated with worse PFS (aHR, 3.015; 95% CI, 1.314–6.919; P=0.009), but not OS (P=0.070).

Conclusions Volumetric sarcopenia increased the recurrence and mortality rates in patients with early cervical cancer. Patients with initial volumetric sarcopenia and total fat gain during primary treatment were at a high risk of disease recurrence.