Introduction This study investigates the influence of sarcopenic status and changes in body composition during cervical cancer treatment on survival outcomes.

Methods Patients diagnosed with stage IB1-IVB cervical cancer who underwent primary concurrent chemoradiation therapy (CCRT) between 2002 and 2022 were included. Exclusions involved prior radical hysterectomy, lack of pre-treatment CT imaging, or significant comorbidities. The DeepCatch AI program analyzed CT images to assess body composition, defining L3 sarcopenia (L3 skeletal muscle index [SMI] <39cm²/m²) and volumetric sarcopenia (volumetric SMI <180.4cm³/m³). Comparative and multivariate analyses were conducted to identify prognostic factors, and the impact of body component changes during CCRT was explored.

Results Among 348 patients, 126 recurrences and 60 deaths occurred during a median 50.5-months follow-up. Patients with L3 sarcopenia had a lower 5-year progression-free survival (PFS) rate (55.6% vs. 66.2%, p=0.027), while volumetric sarcopenic patients showed a poorer 5-year overall survival (OS) rate (76.5% vs. 85.1%, p=0.036). Patients experiencing total fat loss during CCRT had a worse 5-year PFS rate compared to those with total fat gain (61.9% vs. 73.8%, p=0.029). Multivariate analyses revealed that advanced stage (aHR, 2.246, p=0.003) and total fat loss (aHR, 1.883; p=0.046) were significant factors for recurrence, while L3 sarcopenia was not. Volumetric sarcopenia increased the risk of death by 1.75-fold (p=0.045).

Conclusion/Implications Among cervical cancer patients undergoing CCRT, initial volumetric sarcopenia and fat loss during treatment emerges as survival risk factors. The findings suggest the potential importance of personalized supportive care, including tailored nutrition such as high-fat diets and exercise interventions.