Prevalence and associated factors of sarcopenia in cervical cancer patients undergoing chemotherapy

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The objective of our study was to determine the prevalence and associated factors of sarcopenia in cervical cancer (CC) patients followed at Douala General Hospital (DGH). Methods : We conducted a cross-sectional study in the oncology department of DGH, during which sarcopenia was diagnosed in 347 patients with cervical cancer. Body composition was assessed using bioelectrical impedance analysis, and data were analyzed using R and GraphPad software. Univariable and multivariable logistic regression analyses were performed to identify factors associated with sarcopenia. Results : The mean age of patients was 50 ± 10 years, ranging from 25 to 75 years. The overall prevalence of sarcopenia was 43%, with 22% presenting with moderate sarcopenia, 12% with sarcopenia, and 9% with severe sarcopenia. Factors significantly associated with sarcopenia included carboplatin-based chemotherapy protocols (AOR = 3.06, 95% CI = 1.43–6.66, p = 0.004), and being overweight (AOR = 0.27, 95% CI = 0.14–0.51, p < 0.001). Conclusion : The high prevalence of sarcopenia among patients with cervical cancer should alert oncologists to the importance of integrating sarcopenia screening into the routine management of these patients. Sarcopenia prevalence cervical cancer chemotherapy Figures Figure 1 Introduction Cervical cancer remains one of the most common cancers in women, particularly in developing countries ( 1 ). Among the various complications encountered during cancer treatment, sarcopenia is gaining increasing attention ( 2 ). Sarcopenia is defined as a syndrome characterized by a progressive and generalized loss of skeletal muscle mass and strength, potentially leading to reduced physical performance ( 3 ). In oncology, and more specifically in cervical cancer patients, sarcopenia is associated with increased morbidity, reduced treatment tolerance, and impaired quality of life. Moreover, sarcopenia may lead to complications such as fatigue, loss of autonomy, and increased risk of chemotherapy-related toxicity ( 4 ). Therefore, early assessment of sarcopenia is crucial to optimize therapeutic management and improve prognosis ( 5 ). Epidemiologically, the prevalence of sarcopenia in cervical cancer patients varies across regions. Studies conducted in Asia report prevalence rates ranging from 20 to 30% among patients undergoing chemotherapy, while in Europe and the Americas, the prevalence generally varies between 10 and 25% ( 6 , 7 ). In Africa, although data are still limited, prevalence rates appear to be similar or even higher, due to the often-delayed diagnosis of cancer and poor nutritional status ( 8 ). In Cameroon, very few studies have specifically focused on sarcopenia in cervical cancer patients, but the low coverage of oncology care and delayed diagnosis suggest an increased vulnerability ( 9 ). In this context, it is essential to assess the prevalence of sarcopenia and identify its associated factors among cervical cancer patients undergoing chemotherapy at Douala General Hospital. The findings of this study could contribute to developing preventive and management strategies aimed at improving treatment tolerance, quality of life, and ultimately, the prognosis of these patients ( 10 ). The overall objective of our study was to determine the prevalence of sarcopenia and its associated factors among cervical cancer patients undergoing chemotherapy at Douala General Hospital, Cameroon, in order to contribute to the improvement of their clinical management. Patients and Methods Study design Since sarcopenia screening is not part of routine cervical cancer management in Cameroon, we initiated a cross-sectional study to assess the extent of this condition in the oncology department of Douala General Hospital (DGH). The study was conducted over a 6-month period from June to December 2024. The study's objective was explained to each patient who agreed to participate. The risk of sarcopenia was initially evaluated using the SARC-F questionnaire during a one-on-one interview lasting about ten minutes. A SARC-F score ≥ 4 indicated a risk of sarcopenia (11,12). Subsequently, impedance parameters and handgrip strength were measured to confirm the diagnosis. Study population All patients admitted to the oncology department, newly diagnosed with cervical cancer based on histological and biological tests confirmed by a medical oncologist, and receiving their first or subsequent course of chemotherapy, were included upon giving consent. Patients who declined to participate by refusing consent were excluded. Due to the lack of prevalence studies on sarcopenia in Cameroon, we could not estimate a minimum sample size based on prior studies (13). Therefore, the sample size was determined by convenience. A total of 347 cervical cancer patients were included in the study. Data collection Data from each patient were collected using a structured and pre-tested questionnaire. The first section gathered sociodemographic and anthropometric data such as age, height, weight, and body mass index (BMI). The second section collected clinical and therapeutic information related to the disease, including cancer stage, presence or absence of metastases, and treatment protocol used. The final section focused on sarcopenia assessment, including SARC-F responses, handgrip strength, appendicular skeletal muscle mass (ASM), and physical performance (3). Measurement of sarcopenia parameters • Muscle strength measurement Handgrip strength was measured using an electronic dynamometer following the protocol proposed by Roberts et al. (14). This measurement was repeated during subsequent chemotherapy visits. • Muscle mass measurement Muscle mass was assessed by measuring appendicular skeletal muscle mass (ASM) using bioelectrical impedance analysis (BIA), with an integrated equation system calibrated by dual-energy X-ray absorptiometry (DXA), as proposed by Janssen et al. (15). • Physical performance measurement Physical performance was assessed by measuring gait speed over 10 meters, as recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2) (3). Diagnosis of sarcopenia Sarcopenia was diagnosed based on the EWGSOP2 guidelines (3). It was suspected when patients had a SARC-F score ≥ 4 (11), handgrip strength < 16 kg (38), and walking speed < 0.8 m/s (2). Confirmation required the presence of these criteria along with an appendicular skeletal muscle mass (ASM) ≤ 15 kg (16), an appendicular skeletal muscle mass index (ASMI) < 6.75 kg/m², and calf circumference < 31 cm. Sarcopenia severity was then classified according to ASMI values as follows: severe sarcopenia for ASMI ≤ 5.5 kg/m², moderate sarcopenia for ASMI between 5.5 and 6 kg/m², mild sarcopenia for ASMI between 6 and 6.75 kg/m², and no sarcopenia for ASMI ≥ 6.75 kg/m² (17) Ethical considerations Our study was conducted in accordance with ethical guidelines for clinical research involving human participants, as stipulated by the Ministry of Public Health of Cameroon. Administrative authorizations were obtained from the Institutional Ethics Committee for Human Health Research of the University of Douala (No. 3050 CEI-Udo) and from Douala General Hospital (No. 458 AR/MINSANTE/HGD). The purpose and objectives of the study were clearly explained to each participant in the language they best understood (French or English), and only those who signed an informed consent form were included. Participation was entirely voluntary, and patients could refuse to answer specific questions or withdraw from the study at any time, without any impact on their medical care. Additionally, all participants were educated on the importance of maintaining physical activity throughout their treatment. Statistical analysis Data were entered into Excel and analyzed using R version 4.4.2 for Windows 11 or GraphPad version 8.3.4. Qualitative variables were expressed as frequencies (n) and percentages (%), while quantitative variables were presented as means ± standard deviation. Univariable and multivariable logistic regressions were performed to identify factors associated with sarcopenia by calculating Odds Ratios (COR, AOR) with 95% confidence intervals (CI). All statistical tests were conducted with a 95% confidence level and a significance threshold of 5% (p < 0.05) Results General characteristics of the study population The mean age of the patients was 50 ± 10 years, with extremes ranging from 25 to 75 years. Regarding tumor stage, most patients were diagnosed at stage 3 (45%), followed by stage 4 (26%), stage 2 (24%), and stage 1 (4.6%). Metastases were present in 29% of patients, while 71% had no metastases. As for the treatments administered, the most commonly used protocol was Cisplatin (57%), followed by Paclitaxel (23%) and Carboplatin (13%) (Table 1 ) Table 1 General Characteristics of study population Characteristic n(%) Mean age ± sd (years) 50 ± 10[25–75] Stage stage 3 155 (45%) stage 4 91 (26%) stage 2 85 (24%) stage 1 16 (4.6%) Metastasis No 247 (71%) Yes 100 (29%) Protocole Cisplatin 197 (57%) Paclitaxel 81 (23%) Carboplatin 46 (13%) Gemcitabine 12 (3.5%) Doxorubicin 5 (1.4%) 5-Fluorouracil 3 (0.9%) Cyclophosphamide 3 (0.9%) n : frequency , % : percentage , sd : standard deviation Body composition and physical activity The average body weight was 73 ± 16 kg, ranging from 33 to 121 kg. Regarding BMI, 40% of the patients were overweight, 32% were obese, 24% had a normal weight, and 3.7% were underweight. The majority of patients (96%) had a high body fat percentage. In terms of muscle mass, 68% had low muscle mass, while 32% had normal muscle mass. Handgrip strength was normal in 39% of patients, low in 35%, and high in 25%. Finally, 65% of the patients did not engage in any physical activity, whereas 35% reported being physically active (Table 2 ). Table 2 Body composition and physical activity Body composition parameters n(%) Body mass (Kg) 73 ± 16[33–121] Body Mass Index (Kg/m²) overweight 139 (40%) obese 112 (32%) normal 83 (24%) thin 13 (3.7%) Fat mass index (%) high 334 (96%) normal 13 (3.7%) Muscle mass (Kg) low 236 (68%) normal 111 (32%) Hand grip strength (Kg) normal 137 (39%) low 122 (35%) high 88 (25%) Physical activity no 225 (65%) yes 122 (35%) Prevalence of sarcopenia In our sample, 43% of the patients were sarcopenic (Fig. 1 a), among whom 22% had moderate sarcopenia, 12% had sarcopenia, and 9% had severe sarcopenia (Fig. 1 b). Factors associated with sarcopenia Age, cancer stage, and type of treatment protocol were not significantly associated with sarcopenia after adjustment. Regarding BMI, overweight and obesity were significantly associated with a lower risk of sarcopenia (AOR = 0.27, p < 0.001 and AOR = 0.31, p = 0.002, respectively). Low muscle mass significantly increased the risk of sarcopenia (AOR = 2.03, p = 0.021). Similarly, low handgrip strength was strongly associated with sarcopenia (AOR = 4.15, p < 0.001). In contrast, fat mass and physical activity did not show any significant association with sarcopenia (Table 3 ). Table 3 Univariate and multivariate logistic regression analysis of factors associated with sarcopenia Univariate analysis Multivariate analysis Factors COR 95% CI p-value AOR 95% CI p-value Age group 0.69 0.17 25-45years 46-65years 0.82 0.53, 1.29 0.40 0.79 0.46, 1.35 0.39 > 65years 0.82 0.32, 2.05 0.68 0.33 0.10, 1.07 0.068 Stage 0.52 0.93 I II 1.83 0.65, 5.36 0.25 1.07 0.33, 3.57 0.91 III 0.90 0.52, 1.55 0.71 1.20 0.63, 2.28 0.58 IV 1.22 0.72, 2.05 0.46 0.96 0.50, 1.81 0.89 Protocol 0.40 0.058 cisplatin 5-fluorouracil 0.78 0.04, 8.27 0.84 0.28 0.01, 4.19 0.36 carboplatin 1.86 0.97, 3.57 0.061 3.06 1.43, 6.66 0.004 cyclophosphamide 0.78 0.04, 8.27 0.84 1.15 0.04, 15.9 0.92 doxorubicin 0.39 0.02, 2.69 0.40 0.62 0.03, 6.11 0.71 gemcitabine 2.18 0.67, 7.60 0.20 3.37 0.90, 13.4 0.072 paclitaxel 1.25 0.74, 2.10 0.41 1.16 0.61, 2.22 0.64 weight 0.97 0.95, 0.98 < 0.001 0.99 0.97, 1.01 0.19 Body Mass Index < 0.001 < 0.001 normal thin 0.56 0.17, 1.90 0.34 0.50 0.12, 1.94 0.31 overweight 0.29 0.16, 0.51 < 0.001 0.27 0.14, 0.51 < 0.001 obese 0.20 0.11, 0.37 < 0.001 0.31 0.15, 0.66 0.002 Fat mass 0.16 0.13 normal high 0.45 0.13, 1.38 0.17 0.37 0.09, 1.36 0.14 Muscle mass < 0.001 0.020 normal low 3.27 2.00, 5.49 < 0.001 2.03 1.12, 3.74 0.021 Hand grip strength < 0.001 < 0.001 normal low 4.33 2.59, 7.36 < 0.001 4.15 2.32, 7.57 < 0.001 high 0.70 0.38, 1.28 0.25 0.81 0.41, 1.55 0.53 Physical activity 0.49 0.59 yes no 1.17 0.75, 1.84 0.49 1.16 0.67, 2.02 0.59 COR : Crude Odds Ratio; AOR : Ajust Odds Ratio; CI : Confident Interval Discussion The results of our study highlight a high prevalence of sarcopenia (43%) among cervical cancer (CC) patients followed in the oncology department of Douala General Hospital. This proportion, which includes varying degrees of severity (22% moderate sarcopenia, 12% sarcopenia, and 9% severe sarcopenia), confirms the significant role of sarcopenia as a comorbidity and a poor prognostic factor in cancer patients ( 3 ). From an epidemiological perspective, several international studies report sarcopenia prevalence ranging from 15–50%, depending on tumor location, diagnostic criteria, and the studied populations ( 18 , 19 ). In sub-Saharan Africa, data remain limited, but some investigations suggest similar or even higher rates due to socioeconomic conditions, late cancer diagnosis, and limited access to supportive care ( 9 ). The 43% prevalence found in our study thus falls within the upper range of these estimates and underscores the importance of systematically screening for sarcopenia in the management of cervical cancer. Regarding associated factors, the use of carboplatin-based chemotherapy protocols significantly increased the risk of sarcopenia (AOR = 3.06, p = 0.004). Platinum-based chemotherapies (e.g., carboplatin, cisplatin) are commonly associated with side effects such as high toxicity, nutritional impairment, and episodes of nausea and vomiting, all of which can contribute to accelerated muscle mass loss ( 5 , 20 ). As such, the potential toxicity of these protocols may lead to reduced nutritional intake and even physical deconditioning, thereby promoting the onset or worsening of sarcopenia ( 21 ). These findings suggest that closer monitoring, including nutritional support and muscle mass surveillance, could benefit patients receiving such treatments. Paradoxically, being overweight (AOR = 0.27, p < 0.001) appeared as a protective factor in our study. This effect may be partially explained by the fact that body mass index (BMI) does not differentiate between fat mass and muscle mass ( 22 ). Some overweight patients may have greater protein or energy reserves, which could confer better resistance to muscle loss during chemotherapy ( 5 ). However, it is important to note that obesity is not synonymous with good muscle health and may, in fact, mask underlying sarcopenia (sarcopenic obesity), whose prevalence is also increasing in the general population ( 7 ). Therefore, BMI alone should be complemented by detailed assessments of body composition and muscle strength to identify patients at risk. Our findings support the need to consider sarcopenia comprehensively in the management of cervical cancer. Targeted interventions aimed at maintaining or improving muscle mass and function (e.g., adapted physical activity programs, personalized nutritional support) could enhance treatment tolerance, quality of life, and potentially overall survival in these patients ( 3 ). Moreover, the systematic use of sarcopenia screening tools (such as the SARC-F questionnaire, handgrip strength testing, bioelectrical impedance analysis, or DXA) in routine clinical practice would allow for early identification of vulnerable patients and implementation of appropriate management strategies ( 23 ). Finally, some limitations of our study should be acknowledged. The monocentric nature and the sample size—although relatively large—may limit the generalizability of the findings. Additionally, the assessment of sarcopenia relied on methods that may be costly or difficult to access in low-resource healthcare settings ( 24 ). Nevertheless, the study population realistically reflects the diversity of patients treated for cervical cancer in Cameroon, and the insights gained may be valuable for optimizing therapeutic management Conclusion Our study highlights the high prevalence of sarcopenia among cervical cancer patients and demonstrates the association between carboplatin-based chemotherapy protocols and an increased risk of sarcopenia. These findings justify the integration of sarcopenia screening and prevention strategies, along with close nutritional and functional follow-up, into the treatment framework for cervical cancer. Declarations Data availability The data used to support the results of this study are available from the corresponding author on reasonable request. Ethical approval and consent to participate This study was conducted according to the guidelines for clinical research on experimental models for clinical research on humans as indicated by the Ministry of Public Health of Cameroon. Administrative authorizations were issued by the institutional human health research ethics committee of the University of Douala (N° 3050 CEI-Udo) and the Douala General Hospital (N°458 AR/MINSANTE/HGD). Conflicts of interest The authors declare no conflicts of interest. Funding declaration we declare that we have received no funding for this work Authors' contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by A. D. E.N, D. B.E , M. B, S.A,N. G, A.S, M. J.C, and N.P and N. M. W.S. The first draft of the manuscript was written by A.D.E.N, N. M. W.S and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript Acknowledgments The authors thank the women who agreed to participate in the study. References Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. 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Lancet Oncol. juill 2008;9(7):629‑35. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Nkeng","email":"","orcid":"","institution":"General Hospital Of Limbe","correspondingAuthor":false,"prefix":"","firstName":"Glenda","middleName":"","lastName":"Nkeng","suffix":""},{"id":460122106,"identity":"0d8473e8-c69e-40a9-bf72-64bb42011148","order_by":6,"name":"Sidonie Ananga","email":"","orcid":"","institution":"Douala General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sidonie","middleName":"","lastName":"Ananga","suffix":""},{"id":460122107,"identity":"b49cf78b-2baa-4624-9240-79fab0ff8994","order_by":7,"name":"Jean Charles Mananga","email":"","orcid":"","institution":"Douala General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"Charles","lastName":"Mananga","suffix":""},{"id":460122108,"identity":"b881b710-6d9c-41de-a344-9549176b9175","order_by":8,"name":"Paul Ndom","email":"","orcid":"","institution":"University of Yaoundé I","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Ndom","suffix":""}],"badges":[],"createdAt":"2025-03-24 14:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6296114/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6296114/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83421736,"identity":"cbff44f2-5b9f-4de8-b0be-5dd175580201","added_by":"auto","created_at":"2025-05-26 02:15:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90280,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e: Overall prevalence of sarcopenia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e: Specific prevalence of sarcopenia\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6296114/v1/e6d2008d7559ea4d205c3751.jpg"},{"id":108804019,"identity":"90e949f2-1cd3-4bd7-9e1d-6f9b61213e9d","added_by":"auto","created_at":"2026-05-08 15:14:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":489150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6296114/v1/88ec526d-4694-4722-8523-da34cd213d9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and associated factors of sarcopenia in cervical cancer patients undergoing chemotherapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains one of the most common cancers in women, particularly in developing countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Among the various complications encountered during cancer treatment, sarcopenia is gaining increasing attention (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Sarcopenia is defined as a syndrome characterized by a progressive and generalized loss of skeletal muscle mass and strength, potentially leading to reduced physical performance (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn oncology, and more specifically in cervical cancer patients, sarcopenia is associated with increased morbidity, reduced treatment tolerance, and impaired quality of life. Moreover, sarcopenia may lead to complications such as fatigue, loss of autonomy, and increased risk of chemotherapy-related toxicity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Therefore, early assessment of sarcopenia is crucial to optimize therapeutic management and improve prognosis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEpidemiologically, the prevalence of sarcopenia in cervical cancer patients varies across regions. Studies conducted in Asia report prevalence rates ranging from 20 to 30% among patients undergoing chemotherapy, while in Europe and the Americas, the prevalence generally varies between 10 and 25% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Africa, although data are still limited, prevalence rates appear to be similar or even higher, due to the often-delayed diagnosis of cancer and poor nutritional status (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In Cameroon, very few studies have specifically focused on sarcopenia in cervical cancer patients, but the low coverage of oncology care and delayed diagnosis suggest an increased vulnerability (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, it is essential to assess the prevalence of sarcopenia and identify its associated factors among cervical cancer patients undergoing chemotherapy at Douala General Hospital. The findings of this study could contribute to developing preventive and management strategies aimed at improving treatment tolerance, quality of life, and ultimately, the prognosis of these patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The overall objective of our study was to determine the prevalence of sarcopenia and its associated factors among cervical cancer patients undergoing chemotherapy at Douala General Hospital, Cameroon, in order to contribute to the improvement of their clinical management.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince sarcopenia screening is not part of routine cervical cancer management in Cameroon, we initiated a cross-sectional study to assess the extent of this condition in the oncology department of Douala General Hospital (DGH). The study was conducted over a 6-month period from June to December 2024. The study's objective was explained to each patient who agreed to participate. The risk of sarcopenia was initially evaluated using the SARC-F questionnaire during a one-on-one interview lasting about ten minutes. A SARC-F score ≥ 4 indicated a risk of sarcopenia (11,12). Subsequently, impedance parameters and handgrip strength were measured to confirm the diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients admitted to the oncology department, newly diagnosed with cervical cancer based on histological and biological tests confirmed by a medical oncologist, and receiving their first or subsequent course of chemotherapy, were included upon giving consent. Patients who declined to participate by refusing consent were excluded. Due to the lack of prevalence studies on sarcopenia in Cameroon, we could not estimate a minimum sample size based on prior studies (13). Therefore, the sample size was determined by convenience. A total of 347 cervical cancer patients were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from each patient were collected using a structured and pre-tested questionnaire. The first section gathered sociodemographic and anthropometric data such as age, height, weight, and body mass index (BMI). The second section collected clinical and therapeutic information related to the disease, including cancer stage, presence or absence of metastases, and treatment protocol used. The final section focused on sarcopenia assessment, including SARC-F responses, handgrip strength, appendicular skeletal muscle mass (ASM), and physical performance (3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of sarcopenia parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e• Muscle strength measurement\u003c/p\u003e\n\u003cp\u003eHandgrip strength was measured using an electronic dynamometer following the protocol proposed by Roberts et al. (14). This measurement was repeated during subsequent chemotherapy visits.\u003c/p\u003e\n\u003cp\u003e• Muscle mass measurement\u003c/p\u003e\n\u003cp\u003eMuscle mass was assessed by measuring appendicular skeletal muscle mass (ASM) using bioelectrical impedance analysis (BIA), with an integrated equation system calibrated by dual-energy X-ray absorptiometry (DXA), as proposed by Janssen et al. (15).\u003c/p\u003e\n\u003cp\u003e• Physical performance measurement\u003c/p\u003e\n\u003cp\u003ePhysical performance was assessed by measuring gait speed over 10 meters, as recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2) (3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis of sarcopenia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSarcopenia was diagnosed based on the EWGSOP2 guidelines (3). It was suspected when patients had a SARC-F score ≥ 4 (11), handgrip strength \u0026lt; 16 kg (38), and walking speed \u0026lt; 0.8 m/s (2). Confirmation required the presence of these criteria along with an appendicular skeletal muscle mass (ASM) ≤ 15 kg (16), an appendicular skeletal muscle mass index (ASMI) \u0026lt; 6.75 kg/m², and calf circumference \u0026lt; 31 cm. Sarcopenia severity was then classified according to ASMI values as follows: severe sarcopenia for ASMI ≤ 5.5 kg/m², moderate sarcopenia for ASMI between 5.5 and 6 kg/m², mild sarcopenia for ASMI between 6 and 6.75 kg/m², and no sarcopenia for ASMI ≥ 6.75 kg/m² (17)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study was conducted in accordance with ethical guidelines for clinical research involving human participants, as stipulated by the Ministry of Public Health of Cameroon. Administrative authorizations were obtained from the Institutional Ethics Committee for Human Health Research of the University of Douala (No. 3050 CEI-Udo) and from Douala General Hospital (No. 458 AR/MINSANTE/HGD). The purpose and objectives of the study were clearly explained to each participant in the language they best understood (French or English), and only those who signed an informed consent form were included. Participation was entirely voluntary, and patients could refuse to answer specific questions or withdraw from the study at any time, without any impact on their medical care. Additionally, all participants were educated on the importance of maintaining physical activity throughout their treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered into Excel and analyzed using R version 4.4.2 for Windows 11 or GraphPad version 8.3.4. Qualitative variables were expressed as frequencies (n) and percentages (%), while quantitative variables were presented as means ± standard deviation. Univariable and multivariable logistic regressions were performed to identify factors associated with sarcopenia by calculating Odds Ratios (COR, AOR) with 95% confidence intervals (CI). All statistical tests were conducted with a 95% confidence level and a significance threshold of 5% (p \u0026lt; 0.05)\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics of the study population\u003c/h2\u003e \u003cp\u003eThe mean age of the patients was 50\u0026thinsp;\u0026plusmn;\u0026thinsp;10 years, with extremes ranging from 25 to 75 years. Regarding tumor stage, most patients were diagnosed at stage 3 (45%), followed by stage 4 (26%), stage 2 (24%), and stage 1 (4.6%). Metastases were present in 29% of patients, while 71% had no metastases. As for the treatments administered, the most commonly used protocol was Cisplatin (57%), followed by Paclitaxel (23%) and Carboplatin (13%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Characteristics of study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en(%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age\u0026thinsp;\u0026plusmn;\u0026thinsp;sd (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;10[25\u0026ndash;75]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estage 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estage 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetastasis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProtocole\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisplatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197 (57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaclitaxel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarboplatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGemcitabine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoxorubicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-Fluorouracil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCyclophosphamide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e: \u003cem\u003efrequency\u003c/em\u003e, \u003cb\u003e%\u003c/b\u003e: \u003cem\u003epercentage\u003c/em\u003e, \u003cb\u003esd\u003c/b\u003e: \u003cem\u003estandard deviation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBody composition and physical activity\u003c/h2\u003e \u003cp\u003eThe average body weight was 73\u0026thinsp;\u0026plusmn;\u0026thinsp;16 kg, ranging from 33 to 121 kg. Regarding BMI, 40% of the patients were overweight, 32% were obese, 24% had a normal weight, and 3.7% were underweight. The majority of patients (96%) had a high body fat percentage. In terms of muscle mass, 68% had low muscle mass, while 32% had normal muscle mass. Handgrip strength was normal in 39% of patients, low in 35%, and high in 25%. Finally, 65% of the patients did not engage in any physical activity, whereas 35% reported being physically active (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBody composition and physical activity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody composition parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass (Kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;16[33\u0026ndash;121]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody Mass Index (Kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eobese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat mass index (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e334 (96%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMuscle mass (Kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236 (68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHand grip strength (Kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225 (65%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of sarcopenia\u003c/h2\u003e \u003cp\u003eIn our sample, 43% of the patients were sarcopenic (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea), among whom 22% had moderate sarcopenia, 12% had sarcopenia, and 9% had severe sarcopenia (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with sarcopenia\u003c/h2\u003e \u003cp\u003eAge, cancer stage, and type of treatment protocol were not significantly associated with sarcopenia after adjustment. Regarding BMI, overweight and obesity were significantly associated with a lower risk of sarcopenia (AOR\u0026thinsp;=\u0026thinsp;0.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and AOR\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;=\u0026thinsp;0.002, respectively). Low muscle mass significantly increased the risk of sarcopenia (AOR\u0026thinsp;=\u0026thinsp;2.03, p\u0026thinsp;=\u0026thinsp;0.021). Similarly, low handgrip strength was strongly associated with sarcopenia (AOR\u0026thinsp;=\u0026thinsp;4.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, fat mass and physical activity did not show any significant association with sarcopenia (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis of factors associated with sarcopenia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25-45years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46-65years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53, 1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.46, 1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32, 2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.10, 1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65, 5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.33, 3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.52, 1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.63, 2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72, 2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.50, 1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProtocol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecisplatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-fluorouracil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04, 8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01, 4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecarboplatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97, 3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.43, 6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecyclophosphamide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04, 8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.04, 15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edoxorubicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02, 2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03, 6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egemcitabine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67, 7.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.90, 13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epaclitaxel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74, 2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.61, 2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95, 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.97, 1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody Mass Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.17, 1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.12, 1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16, 0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14, 0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eobese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11, 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15, 0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat mass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13, 1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09, 1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMuscle mass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.00, 5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.12, 3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHand grip strength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.59, 7.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.32, 7.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38, 1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.41, 1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75, 1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.67, 2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOR\u003c/b\u003e : \u003cem\u003eCrude Odds Ratio;\u003c/em\u003e \u003cb\u003eAOR\u003c/b\u003e: \u003cem\u003eAjust Odds Ratio;\u003c/em\u003e \u003cb\u003eCI\u003c/b\u003e: \u003cem\u003eConfident Interval\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The results of our study highlight a high prevalence of sarcopenia (43%) among cervical cancer (CC) patients followed in the oncology department of Douala General Hospital. This proportion, which includes varying degrees of severity (22% moderate sarcopenia, 12% sarcopenia, and 9% severe sarcopenia), confirms the significant role of sarcopenia as a comorbidity and a poor prognostic factor in cancer patients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom an epidemiological perspective, several international studies report sarcopenia prevalence ranging from 15\u0026ndash;50%, depending on tumor location, diagnostic criteria, and the studied populations (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In sub-Saharan Africa, data remain limited, but some investigations suggest similar or even higher rates due to socioeconomic conditions, late cancer diagnosis, and limited access to supportive care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The 43% prevalence found in our study thus falls within the upper range of these estimates and underscores the importance of systematically screening for sarcopenia in the management of cervical cancer.\u003c/p\u003e \u003cp\u003eRegarding associated factors, the use of carboplatin-based chemotherapy protocols significantly increased the risk of sarcopenia (AOR\u0026thinsp;=\u0026thinsp;3.06, p\u0026thinsp;=\u0026thinsp;0.004). Platinum-based chemotherapies (e.g., carboplatin, cisplatin) are commonly associated with side effects such as high toxicity, nutritional impairment, and episodes of nausea and vomiting, all of which can contribute to accelerated muscle mass loss (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). As such, the potential toxicity of these protocols may lead to reduced nutritional intake and even physical deconditioning, thereby promoting the onset or worsening of sarcopenia (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These findings suggest that closer monitoring, including nutritional support and muscle mass surveillance, could benefit patients receiving such treatments.\u003c/p\u003e \u003cp\u003eParadoxically, being overweight (AOR\u0026thinsp;=\u0026thinsp;0.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) appeared as a protective factor in our study. This effect may be partially explained by the fact that body mass index (BMI) does not differentiate between fat mass and muscle mass (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Some overweight patients may have greater protein or energy reserves, which could confer better resistance to muscle loss during chemotherapy (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, it is important to note that obesity is not synonymous with good muscle health and may, in fact, mask underlying sarcopenia (sarcopenic obesity), whose prevalence is also increasing in the general population (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Therefore, BMI alone should be complemented by detailed assessments of body composition and muscle strength to identify patients at risk.\u003c/p\u003e \u003cp\u003eOur findings support the need to consider sarcopenia comprehensively in the management of cervical cancer. Targeted interventions aimed at maintaining or improving muscle mass and function (e.g., adapted physical activity programs, personalized nutritional support) could enhance treatment tolerance, quality of life, and potentially overall survival in these patients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Moreover, the systematic use of sarcopenia screening tools (such as the SARC-F questionnaire, handgrip strength testing, bioelectrical impedance analysis, or DXA) in routine clinical practice would allow for early identification of vulnerable patients and implementation of appropriate management strategies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, some limitations of our study should be acknowledged. The monocentric nature and the sample size\u0026mdash;although relatively large\u0026mdash;may limit the generalizability of the findings. Additionally, the assessment of sarcopenia relied on methods that may be costly or difficult to access in low-resource healthcare settings (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Nevertheless, the study population realistically reflects the diversity of patients treated for cervical cancer in Cameroon, and the insights gained may be valuable for optimizing therapeutic management\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlights the high prevalence of sarcopenia among cervical cancer patients and demonstrates the association between carboplatin-based chemotherapy protocols and an increased risk of sarcopenia. These findings justify the integration of sarcopenia screening and prevention strategies, along with close nutritional and functional follow-up, into the treatment framework for cervical cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the results of this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the guidelines for clinical research on experimental models for clinical research on humans as indicated by the Ministry of Public Health of Cameroon. Administrative authorizations were issued by the institutional human health research ethics committee of the University of Douala (N° 3050 CEI-Udo) and the Douala General Hospital (N°458 AR/MINSANTE/HGD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewe declare that we have received no funding for this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by A. D. E.N, D. B.E , M. B, S.A,N. G, A.S, M. J.C, and N.P and N. M. W.S. The first draft of the manuscript was written by A.D.E.N, N. M. W.S \u0026nbsp;and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the women who agreed to participate in the study. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSingh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. f\u0026eacute;vr 2023;11(2):e197‑206. \u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruy\u0026egrave;re O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 1 juill 2019;48(4):601. \u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. juill 2010;39(4):412‑23. \u003c/li\u003e\n\u003cli\u003eWang M, Zhu Y, Ju Y, Long T, Jin L, Zhang J, et al. Changes in Nutritional Status of Cancer Patients Undergoing Proton Radiation Therapy Based on Real-World Data. Journal of Healthcare Engineering [Internet]. 2023 [cit\u0026eacute; 14 f\u0026eacute;vr 2025];2023(1):9260747. Disponible sur: https://onlinelibrary.wiley.com/doi/abs/10.1155/2023/9260747\u003c/li\u003e\n\u003cli\u003eMartin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 20 avr 2013;31(12):1539‑47. \u003c/li\u003e\n\u003cli\u003eLee BM, Cho Y, Kim JW, Jeung HC, Lee IJ. Prognostic Significance of Sarcopenia in Advanced Biliary Tract Cancer Patients. Front Oncol. 2020;10:1581. \u003c/li\u003e\n\u003cli\u003ePrado CM, Sawyer MB, Ghosh S, Lieffers JR, Esfandiari N, Antoun S, et al. Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential? Am J Clin Nutr. oct 2013;98(4):1012‑9. \u003c/li\u003e\n\u003cli\u003eAudain K, Carr M, Dikmen D, Zotor F, Ellahi B. Exploring the health status of older persons in Sub-Saharan Africa. Proceedings of the Nutrition Society [Internet]. nov 2017 [cit\u0026eacute; 14 f\u0026eacute;vr 2025];76(4):574‑9. Disponible sur: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/exploring-the-health-status-of-older-persons-in-subsaharan-africa/58B47AB3069E7B8A0CF6A7B093F5F088\u003c/li\u003e\n\u003cli\u003eManga S, Kanjo M, Ngwa W. 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Lancet Oncol. juill 2008;9(7):629‑35. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sarcopenia, prevalence, cervical cancer, chemotherapy","lastPublishedDoi":"10.21203/rs.3.rs-6296114/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6296114/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Sarcopenia is a poor prognostic factor that negatively impacts overall survival and quality of life in cancer patients. The objective of our study was to determine the prevalence and associated factors of sarcopenia in cervical cancer (CC) patients followed at Douala General Hospital (DGH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We conducted a cross-sectional study in the oncology department of DGH, during which sarcopenia was diagnosed in 347 patients with cervical cancer. Body composition was assessed using bioelectrical impedance analysis, and data were analyzed using R and GraphPad software. Univariable and multivariable logistic regression analyses were performed to identify factors associated with sarcopenia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The mean age of patients was 50 ± 10 years, ranging from 25 to 75 years. The overall prevalence of sarcopenia was 43%, with 22% presenting with moderate sarcopenia, 12% with sarcopenia, and 9% with severe sarcopenia. Factors significantly associated with sarcopenia included carboplatin-based chemotherapy protocols (AOR = 3.06, 95% CI = 1.43–6.66, p = 0.004), and being overweight (AOR = 0.27, 95% CI = 0.14–0.51, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The high prevalence of sarcopenia among patients with cervical cancer should alert oncologists to the importance of integrating sarcopenia screening into the routine management of these patients.\u003c/p\u003e","manuscriptTitle":"Prevalence and associated factors of sarcopenia in cervical cancer patients undergoing chemotherapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 02:07:45","doi":"10.21203/rs.3.rs-6296114/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3db5e4ce-232a-4314-bc44-46bc2092a098","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-05T02:43:55+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T02:55:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 02:07:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6296114","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6296114","identity":"rs-6296114","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}