Pretreatment anemia and low skeletal muscle index as predictors of poor prognostic in cervical cancer patients

Background: Locally advanced cervical cancer (CC) is mostly treated with concurrent chemoradiotherapy (CCRT). The amount of local extension of the disease and lymph-node invasion are the most important factors related to a worse progression-free survival (PFS) and overall survival (OS). Moreover, recently, anemia and skeletal muscle index (SMI) appears as important predictors of clinical outcomes in patients with cancer, demonstrating the association of low haemoglobin level and SMI with worse PFS and OS. However, there is no consensus about the clinical impact of pretreatment anemia and low SMI in women with CC. Objective: To evaluate pretreatment level of haemoglobin and SMI as a prognostic factors in women diagnosed with CC that CCRT. Methods: 151 women diagnosed with CC were included in this cohort study with retrospective data collection. Pretreatment computerized tomography (CT) images were analysed to assess SMI. Hazard ratios (HR) and multivariate Cox proportional HR with (95%CI) were used to analyse the association between low SMI, age, menstrual state, body mass index (BMI), haemoglobin levels, neutrophil and platelet count, histological type, and FIGO stage with PFS and OS. The Kaplan-Meier method was used to analyse the survival of patients with or without low SMI according to stages. Results: Among the 151 patients included, 53 (35.1%) presented pretreatment low SMI. Linear regression models showed that despite showing no association with age, neutrophil or platelet counts, low SMI was associated with low pretreatment haemoglobin levels (p = 0.01). After a multivariate analysis, only haemoglobin and complete CCRT remained associated with DFS (p < 0.001) and OS (p < 0.001). Low SMI was significantly associated with worse PFS and OS in FIGO stage I/II. Conclusion: Pretreatment low level of haemoglobin was significantly associated with low SMI. However, only anemia and incomplete CCRT were independently associated with poor prognosis in women with CC. Pretreatment low SMI was a predictor of poor prognostic in early stages.