Dados do Resumo

Título

Preoperative muscle mass assessment with computed tomography in patients with gynecological neoplasms

Introdução

Gynecological cancers are among the ten most common cancers affecting women worldwide, with considerable mortality. Measuring body weight alone is a flawed indicator because it does not show body composition., as other changes such as loss of muscle mass or the deposition of adipose tissue in different body compartments remain indiscernible to the observer when only body weight is assessed. The gold standard method for assessing muscle mass is a CT scan at the L3 lumbar level. Loss of muscle mass should be assessed for preoperative risk stratification in this population and may be predictive of post-surgical complications.

Objetivo

To assess muscle mass in patients with gynecological malignancies during the preoperative period in a cancer hospital. To assess whether there is an association between low muscle mass and clinical, nutritional and postoperative characteristics in patients with gynecological malignancies.

Métodos

A descriptive study with retrospective data collection was submitted and approved by the Research Ethics Committee of the A.C. Camargo Cancer Center (CAAE: 67026523.0.0000.5432). Electronic medical records of patients with gynecological cancer undergoing surgical treatment from January 2020 to July 2022 were collected. Muscle mass was assessed using computed tomography images. A semi-automatic method was used to measure muscle surface areas (skeletal muscles such as the paravertebral, psoas and abdominal muscles). A density of -29 to +150 HU was considered. The area of muscle mass was corrected for height to calculate the muscle mass index (MMI). A MMI of less than 38.9 cm2/m2 was classified as low muscle mass. Descriptive statistics were used for the statistical analysis with the usual measures of central tendency (mean and standard deviation) and simple and relative frequencies.The following tests were used to analyze the association between categorical variables Chi-Square and Fisher's Exact Test were used. The Student's T-test and Mann-Whitney test were used to check whether the distribution of numerical variables was the same in the groups evaluated. O significance level adopted was 5%.

Resultados

One hundred thirty eight women were included in the study. Of these, 24% had a low MMI. There was an association between preoperative chemotherapy and radiotherapy with low muscle mass (p=0.003 and p=0.002) respectively, as well as with the need for invasive mechanical ventilation in the postoperative period (p=0.024) and Performance Status do Eastern Cooperative Oncology Group (ECOG) (p=0.005).

Conclusões

There was an association between preoperative chemotherapy and radiotherapy and low muscle mass. A association was observed between low muscle mass and the functional capacity of these patients. Notably, those with low muscle mass had a greater need for invasive mechanical ventilation in the postoperative period. These findings highlight the importance of a multidisciplinary approach to the assessment and proper management of body composition, with the aim of minimizing perioperative complications in order to minimize perioperative complications and optimize clinical outcomes.

Palavras Chave

low muscle mass; gynecological malignances; computed tomography