L. Paul1, Z. Sun2, Y. Ma2, and E. D. Donnelly3; 1Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA, 2Northwestern University, Chicago, IL, 3Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
Purpose/Objective(s): Cachexia is a multifactorial process characterized by loss of skeletal muscle and adipose tissue and has been associated with a worse prognosis. Few studies have looked at the prevalence of cachexia in gynecological cancers, especially cervical cancer. Given the relationships of cancer cachexia and prognosis in other cancers, it can be hypothesized that cervical cancer cachexia may provide prognostic information as well. Our study aimed to evaluate the impact of cachexia, defined by volumetric assessment on CT imaging, on disease recurrence and survival. Materials/
Methods: After institutional review board approval, we retrospectively reviewed all non-metastatic cervical cancer treated at our institution from 2005 to 2023. The electronic health record was used to identify eligible patients and gather baseline patient, tumor, treatment, and outcome data. Pre-radiation planning CT images were used to collect cachexia indices. Cachexia indices were assessed by measurements of skeletal muscles in the axial plane at the mid L3 level. For each contour, skeletal muscle area (SMA) and skeletal muscle index (SMI) were obtained. The L3 skeletal muscle index has been previously reported and calculated in previous studies as follows: SMI = (Total L3 SMA (cm2)/Patient Height (m2)) Overall and recurrence-free survival were estimated using the Kaplan-Meir method. Cox proportional hazards models were used to identify other variables associated with overall and recurrence-free survival. Logistic regression models were used to analyze the relationship between cachexia and disease recurrence. Results: A total of 88 patients were eligible for analysis. Of the 88 patients, 67 did not have disease recurrence while 21 patients did have disease recurrence. Patients with node positive disease were significantly more likely to have disease recurrence (p= <0.001) as well as patients whose cachexia volumes were in the bottom 10% of all patients measured (SMI lower 10%) (p=0.032). The recurrence-free survival was significantly decreased in the SMI lower 10% group (p=0.047). At 1 and 5 years, those without cachexia had a recurrence probability of 0.874 and 0.742 respectively, those with cachexia (lower 10%) had a recurrence probability of 0.635 and 0.508 respectively. Cox-proportional hazards regression showed that cachexia (lower 10%) (p=0.046) and tumor size (p=0.034) were noted to be driving factors of overall survival on multivariable analysis. Logistic regression showed significance for recurrence with cachexia by SMI measured at mid-level alone and measuring only abdominal muscles (lower 10%) on univariable analysis (p = 0.028 for both). Conclusion: In the present study, SMI (lower 10%) was statistically associated with decreased recurrence survival. This study demonstrates, in advanced cervical cancer, cachexia indices may be utilized to assess prognosis.
