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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 surviva...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061344/ https://www.ncbi.nlm.nih.gov/pubmed/33543597 http://dx.doi.org/10.1002/jcsm.12676 |
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author | Sehouli, Jalid Mueller, Kristina Richter, Rolf Anker, Markus Woopen, Hannah Rasch, Julia Grabowski, Jacek P. Prinz‐Theissing, Eva Inci, Melisa Guelhan |
author_facet | Sehouli, Jalid Mueller, Kristina Richter, Rolf Anker, Markus Woopen, Hannah Rasch, Julia Grabowski, Jacek P. Prinz‐Theissing, Eva Inci, Melisa Guelhan |
author_sort | Sehouli, Jalid |
collection | PubMed |
description | 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°, 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° (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° (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 < 4.75° and FIGO stage ≥ III A are significantly associated with severe postoperative complications within the first month. Whereas ECOG status > 1, hypoalbuminemia, phase angle < 4.5° as well as FIGO stage ≥ III A and severe postoperative complications within 30 days correlate significantly with poor overall survival. |
format | Online Article Text |
id | pubmed-8061344 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80613442021-04-23 Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study Sehouli, Jalid Mueller, Kristina Richter, Rolf Anker, Markus Woopen, Hannah Rasch, Julia Grabowski, Jacek P. Prinz‐Theissing, Eva Inci, Melisa Guelhan J Cachexia Sarcopenia Muscle Original Articles 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°, 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° (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° (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 < 4.75° and FIGO stage ≥ III A are significantly associated with severe postoperative complications within the first month. Whereas ECOG status > 1, hypoalbuminemia, phase angle < 4.5° as well as FIGO stage ≥ III A and severe postoperative complications within 30 days correlate significantly with poor overall survival. John Wiley and Sons Inc. 2021-02-04 2021-04 /pmc/articles/PMC8061344/ /pubmed/33543597 http://dx.doi.org/10.1002/jcsm.12676 Text en © 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Sehouli, Jalid Mueller, Kristina Richter, Rolf Anker, Markus Woopen, Hannah Rasch, Julia Grabowski, Jacek P. Prinz‐Theissing, Eva Inci, Melisa Guelhan Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title | Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title_full | Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title_fullStr | Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title_full_unstemmed | Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title_short | Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
title_sort | effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061344/ https://www.ncbi.nlm.nih.gov/pubmed/33543597 http://dx.doi.org/10.1002/jcsm.12676 |
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