Sarcopenia as an independent prognostic marker in liposarcoma: A longitudinal analysis of body composition and survival

Abstract

Background Sarcopenia is increasingly recognized as an important prognostic factor in oncology; however, its clinical relevance in liposarcoma remains insufficiently defined. This study aimed to evaluate longitudinal changes in CT-derived body composition parameters in liposarcoma patients, to assess the influence of tumor grade, recurrence, and treatment modalities on these parameters and to determine the association of baseline sarcopenia and progressive muscle loss with overall survival and functional status. Methods In a retrospective, single center study between 2010 and 2024, 64 patients were analyzed. All patients underwent surgical tumor resection of a histologically confirmed liposarcoma. Included were patients with two consecutive CT scans. The following morphometric parameters were measured on CT axial images at the height of lumbar vertebral 3: Skeletal muscle index (SMI), paraspinal muscle index (PSMI), psoas muscle index (PMI), skeletal muscle density (SMD), and visceral adipose tissue (VAT). Standardized Hounsfield unit thresholds were used for the assessment. Additionally, the influence of tumor grade, recurrence, and treatment modalities on body composition was assessed. A Kaplan Meier survival analysis was performed using data from the residents´ registration office. Survival was further analyzed by Cox regression using uni- and multivariate models. Metric data was compared using student´s t-test. Results Significant reductions in SMI, PSMI, PMI, and VAT were observed over the disease course, particularly among patients with high-grade tumors, chemotherapy, or local tumor recurrence. Baseline sarcopenia and a progressive SMI loss were independently associated with reduced overall survival. In multivariate analysis, baseline sarcopenia (HR: 2.331, p  = 0.007) and a ≥ 15% SMI decline (HR: 2.601, p  = 0.006) remained significant predictors of mortality. Both markers did not correlate with changes in Eastern Cooperative Oncology Group (ECOG) performance status. Conclusion CT-morphometric parameters deteriorate substantially during the disease course of liposarcoma patients and serve as independent predictors of survival. These findings support the integration of CT-based body composition analysis into routine oncologic assessment and highlight its potential role in identifying high-risk patients for early supportive intervention.