Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study

Background Malnutrition and sarcopenia often occur simultaneously in cancer patients and are thought to have harmful effects on both surgical and oncological outcomes. Therefore, we want to evaluate the effects of sarcopenia and malnutrition on severe postoperative complications and overall survival in gynecologic cancer patients. Methods We assessed nutritional parameters and run a bioelectrical impedance analysis in 226 women. Extracellular mass to body cell mass index, phase angle alpha, muscle mass, and fat mass were evaluated. To determine if patients suffer from sarcopenia, we ran the Timed 'Up and Go' test, performed hand grip strength, and calculated a skeletal muscle index. Postoperative complications were categorized using Clavien-Dindo Classification. Utilizing ROC analysis and logistic regression, we determined predictive clinical factors for severe postoperative complications. Kaplan-Meier method and log-rank test were used for overall survival analysis. Results Of the 226 female patients, 120 (53%) had a BMI >= 25 kg/m(2), 56 (26%) had a phase angle < 4.75 degrees, and 68 (32%) were sarcopenic according to skeletal muscle index < 27%. Within 30 days after surgery, 40 (18%) patients developed severe postoperative complications, and 4% had died. According to multivariable regression analysis, ECOG status > 1 (OR 4.56, 95% CI: 1.46-14.28, P = 0.009), BMI >= 25 kg/m(2) (OR 8.22, 95% CI: 3.01-22.48, P < 0.001), phase angle < 4.75 degrees (OR 3.95, 95% CI: 1.71-9.10, P = 0.001), and tumour stage >= III A (OR 3.65, 95% CI: 1.36-9.76, P = 0.01) were predictors of severe postoperative complications. During 59 months of follow-up, 108 (48%) patients had died. According to multivariable Cox regression ECOG status > 1 (HR 2.51, 95% CI: 1.25-5.03, P = 0.01), hypoalbuminemia (HR 2.15, 95% CI: 1.28-3.59, P = 0.004), phase angle < 4.5 degrees (HR 1.76, 95% CI 1.07-2.90, P = 0.03), tumour stage >= III A (HR 2.61, 95% CI: 1.53-4.45, P < 0.001), and severe postoperative complications (HR 2.82, 95% CI: 1.80-4.41, P < 0.001) were predictors of overall mortality. Conclusions We observed that preoperatively assessed ECOG status > 1, BMI > 25 kg, as well as phase angle alpha 1, hypoalbuminemia, phase angle < 4.5 degrees as well as FIGO stage >= III A and severe postoperative complications within 30 days correlate significantly with poor overall survival.

Automated summary

The study evaluated the effects of sarcopenia and malnutrition on severe postoperative complications and overall survival in gynecologic cancer patients. Factors such as ECOG status, BMI, phase angle, skeletal muscle index, and tumor stage were found to be predictors of postoperative complications and overall mortality. Preoperative assessment of these factors may help in identifying patients at higher risk for poor outcomes.