***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective Cancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion ( sarcopenia ) . Although weight loss has been associated with poor clinical outcome , there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far . Methods Total skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer . Longitudinal change of muscle mass was studied in  209 consecutive computed tomography scans  from 43 patients . Association with survival was determined using Cox proportional hazards model . Results The prevalence of sarcopenia at first diagnosis was 11 % ( 12/105 ; 95 % confidence interval [ CI ] , 6%–20 % ) . Sarcopenic patients had a significantly reduced progression-free ( hazard ratio , 2.64 ; 95 % CI , 1.24–5.64 ; P = 0.012 ) and overall survival ( hazard ratio , 3.17 ; 95 % CI , 1.29–7.80 ; P = 0.012 ) . On multivariable analysis , these prognostic effects remained significant after adjustment for age , International Federation of Gynecology and Obstetrics stage , and postsurgical residual disease . Longitudinal analyses identified both patients with loss and gain of muscle mass . However , change in muscle mass over time was not associated with survival . Conclusions Baseline sarcopenia is a prognostic factor in advanced serous ovarian cancer . Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospect i ve clinical trials Abstract Background Malnutrition , weight loss , and muscle wasting ( sarcopenia ) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival . Our objective is to investigate overall survival ( OS ) related to changes in skeletal muscle ( SM ) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking .  Methods Ovarian cancer patients ( n = 123 ) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht ( the Netherl and s ) between 2000 and 2014 were included retrospectively . Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra . Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves , and Cox‐regression models were applied to test predictors of OS . Results Median OS for patients who lost SM ( n = 83 ) was 916 ± 99 days , which was significantly different from median OS for patients who maintained or gained SM ( n = 40 ) , which was 1431 ± 470 days ( P = 0.004 ) . Loss of SM was also a significant predictor of OS in multivariable Cox‐regression analysis ( hazard ratio 1.773 ( 95%CI : 1.018–3.088 ) , P = 0.043 ) . Low baseline SM did not influence survival . Conclusions Patients with ovarian cancer have a worse survival when they lose SM during neoadjuvant chemotherapy . Evaluation of low SM at a specific time point is not prognostic for OS . External and prospect i ve validation of these findings is imperative . Nutritional , pharmacological , and /or physical intervention studies are necessary to establish whether SM impairment can be prevented to prolong ovarian cancer survival OBJECTIVE To prospect ively examine body weight changes in women with newly diagnosed ovarian cancer receiving surgery and adjuvant chemotherapy .  Body composition was examined in a subset of these women . METHODS Body weight ( BW ) and body composition , using bioelectrical impedance  ( RJL Systems Inc. ) , were prospect ively measured pre- and post-operatively , and at 3 , 6 , and 12 months . RESULTS Mean age of 42 women was 59 years and did not differ by stage of disease . Nine women with early stage disease did not receive adjuvant chemotherapy .  Mean BW of 33 patients receiving chemotherapy decreased from the pre- to post-operative visit and then returned to baseline levels by 12 months ( F = 8.70 , P = 0.003 ) . Nine patients who did not receive chemotherapy demonstrated a similar pattern ( F = 7.0 , P = 0.002 ) . Women receiving chemotherapy with stage I/II cancer had a 2.8 + /- 2.0 kg weight gain over the year , and women with stage III/IV cancer had a 1.5 + /- 1.5 kg weight loss ( t = 1.72 , P = 0.096 ) . A subset of women with stage I/II ( n = 6 ) and stage III/IV ( n = 6 ) ovarian cancer receiving chemotherapy had body composition measured at three time points . Absolute body fat changes paralleled changes in BW ( F = 9.95 , P = 0.002 ) . CONCLUSIONS Our study is the first prospect i ve evaluation of body weight and composition in women undergoing surgery and chemotherapy for ovarian cancer . These results demonstrate that women undergoing surgery for ovarian cancer lost weight following surgery and regained it slowly over the following year . Further investigations of weight changes during adjuvant chemotherapy are indicated to assess potential changes in different stages of disease BACKGROUND Sarcopenia , severe skeletal muscle loss , has been identified as a prognostic factor in various malignancies . This study aims to investigate whether sarcopenia is associated with overall survival ( OS ) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery ( PDS ) .  METHODS Ovarian cancer patients ( n = 216 ) treated with PDS were enrolled retrospectively .  Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra . Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia ( ≤38.73 cm2/m2 ) . Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS . The effect of sarcopenia on the development of major surgical complications was studied with logistic regression . RESULTS Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia ( p = 0.010 ) . Sarcopenia univariably predicted OS ( HR 1.536 ( 95 % CI 1.105 - 2.134 ) , p = 0.011 ) but was not significant in multivariable Cox-regression analysis ( HR 1.362 ( 95 % CI 0.968 - 1.916 ) , p = 0.076 ) . Significant predictors for OS in multivariable Cox-regression analysis were complete PDS , treatment in a specialised centre and the development of major complications . Sarcopenia was not predictive of major complications . CONCLUSION Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery . However a strong trend towards a survival disadvantage for patients with sarcopenia was seen . Future prospect i ve studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival . Complete cytoreduction remains the strongest predictor of ovarian cancer survival Emerging research suggests that body composition can predict toxicity of certain chemotherapeutic agents . We used data from a clinical study to investigate associations between body composition and combined DOXIL ( pegylated liposomal doxorubicin ; PLD ) and trabectedin ( Yondelis ) treatment , an effective treatment for ovarian cancer that shows high interpatient variation in toxicity profile . Patients ( n = 74 ) participating in a phase III r and omized trial of relapsed advanced ovarian cancer receiving PLD ( 30 mg/m(2 ) ) and trabectedin ( 1.1 mg/m(2 ) ) were included .  Muscle tissue was measured by analysis of computerized tomography images , and an extrapolation of muscle and adipose tissue to lean body mass ( LBM ) and fat mass ( FM ) were employed . Toxicity profile after cycle 1 was used and grade d according to the National Cancer Institute Common Toxicity Criteria ( version 3 ) . Patients presented with a wide range of body composition . In overweight and obese patients ( body mass index ( BMI ) ≥ 25 kg/m(2 ) , n = 48 ) toxicity was more prevalent in those with lower BMI ( p = 0.028 ) and a lower FM ( n = 43 , p = 0.034 ) . Although LBM alone was not predictive of toxicity , a lower FM/LBM ratio was the most powerful variable associated with toxicity ( p = 0.006 ) . A different pattern emerged among normal weight patients ( n = 26 ) where toxicity was rare among patients with smaller BMI ( < 21 kg/m(2 ) ) . A clear association between both FM and LBM ( primarily driven by FM ) in explaining PLD plus trabectedin toxicity emerged , but only in individuals with excess body weight , with a lower ratio predicting higher exposure and risk for toxicity OBJECTIVE To investigate whether patients ' altered body composition ( measured with bioimpedentiometry ) , due to a poor nutritional status , predicts the incidence of no residual disease at primary debulking and the risk of complications in patients with newly-diagnosed advanced epithelial ovarian cancer ( EOC ) . METHODS Data regarding patients with newly-diagnosed stage IIIC-IV EOC undergoing elective nutritional assessment between December 2016 and March 2017 , were prospect ively collected . Bioelectrical impedance analysis ( BIA ) with measurement of BIA-derived phase angle [ PhA ] at 50KHz , was accomplished . Only patients with disease which was considered resectable at staging laparoscopy were su bmi tted to open primary cytoreduction . The rate of residual tumor (RT)=0 and the incidence of complications were assessed . RESULTS Seventy patients were included . Fifty-two of them were su bmi tted to primary cytoreduction ( 74.3 % ) and 48 ( 68.6 % of the entire cohort , 92.3 % of those who underwent primary debulking ) had RT=0 at the end of surgery . Median values of PhA were significantly lower in patients with RT > vs . = 0 ( 4.7 , range : 3.6 - 5.8 vs. 5.3 , range : 4.2 - 6.8 ; p=0.001 ) . Twenty-four ( out of the 52 operated ) patients ( 46.2 % ) developed at least one complication . PhA was significantly lower in patients with vs. without complications ( 5 , range : 3.6 - 6.4 , vs. 5.4 , range 4.5 - 6.8 ; p=0.03 ) . After multivariable analysis , Fagotti score and PhA were the only independent predictors of residual disease ( OR:13.56 ; 95%CI:1.33 - 137.6 ; p=0.027 and 9.24 ; 1.16 - 73.43 ; p=0.036 , respectively ) and of any complication ( OR:4.9;95%CI:1.17 - 20.6 ; p=0.03 and 7.27 ; 1.45 - 36.4 ; p=0.01 , respectively ) . CONCLUSIONS Derangement of body composition ( likely due to disease-related malnutrition ) expressed as a low phase angle , is an independent predictor of residual disease and peri-operative complications at the time of upfront cytoreduction for advanced EOC INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic OBJECTIVE Adiposity has been hypothesized to interfere with the activity of bevacizum 
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Moreover , the heterogeneity between studies precluded the possibility of performing a meta- analysis and reaching conclusions for progression free survival , disease free survival , surgical complications , and chemotoxicity .
CONCLUSIONS This work suggested that the measurement of skeletal muscle radiodensity by routine CT scan at diagnosis , with st and ardization of diagnostic criteria , could be a reliable tool to select at risk patients and to individualize effective nutritional strategies .