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1006 Prognostic implications of body composition in cervical cancer patients who underwent concurrent chemoradiation therapy as a primary treatment: a clinical research utilizing an artificial intelligence-based volumetrics
  1. Hyunji Lim,
  2. Joo Won Lee,
  3. Se Ik Kim,
  4. Maria Lee,
  5. Hee Seung Kim,
  6. Hyun Hoon Chung,
  7. Noh Hyun Park and
  8. Jae-Weon Kim
  1. Seoul National University College of Medicine, Seoul, South Korea

Abstract

Introduction/Background Tumor progression induces a hypermetabolic state in the tumor microenvironment, affecting lipolysis and protein degradation. This study explores the impact of baseline sarcopenic status and changes in body composition during cervical cancer treatment on survival outcomes.

Methodology Patients diagnosed with stage IB1-IVB cervical cancer receiving primary concurrent chemoradiation therapy (CCRT) between January 2002 and June 2022 were included. Exclusions involved prior radical hysterectomy, lack of pre-treatment CT imaging, or significant comorbidities. The DeepCatch artificial intelligence program analysed CT images for body composition. L3 sarcopenia (L3 skeletal muscle index [SMI] <39cm2/m2) and volumetric sarcopenia (volumetric SMI <180.4cm3/m3) was defined. Comparative analyses between sarcopenic and non-sarcopenic patients and multivariate analyses for prognostic factors were conducted. Additionally, analyses were performed between the gain or the loss of body component (muscle and fat component) during CCRT.

Results Among 348 patients, over half had stage IIB disease, with squamous cell carcinoma as the majority. During a median 50.5-months follow-up, 126 recurrences and 60 deaths occurred. L3 sarcopenic patients had a worse 5-year progression-free survival (PFS) rate (55.6% vs. 66.2%, p=0.027), but no overall survival (OS) difference. Conversely, volumetric sarcopenic patients showed a poorer 5-year OS rate (76.5% vs. 85.1%, p=0.036), with no PFS difference. Furthermore, patients with total fat loss after CCRT demonstrated a worse 5-year PFS rate than those with total fat gain (61.9% vs. 73.8%, p=0.029), without significant difference for OS. In multivariate analyses, only advanced stage (aHR, 2.246, p=0.003) and total fat loss (aHR, 1.883; p=0.046) were significant for recurrence, while L3 sarcopenia was not. Volumetric sarcopenia increased the risk of death by 1.75-fold (p=0.045).

Conclusion Among cervical cancer patients undergoing CCRT, baseline volumetric sarcopenic status and experiencing fat loss during treatment are notable survival risk factors, underscoring the potential necessity for personalised supportive care, including tailored nutrition (e.g. high-fat diets) and exercise interventions.

Disclosures I have no conflict of interest to disclose.

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