Influence of nutritional status on survival in patients treated for retroperitoneal sarcomaRamanović, Manuel (Avtor) Rotovnik Kozjek, Nada (Mentor) Perhavec, Andraž (Komentor) malnutritionsarcopeniacancer cachexiainflammationnutritionbody compositionsurgical oncologyretroperitoneal sarcomaRetroperitoneal sarcomas (RPS) are rare connective tissue malignancy posing both diagnostic and therapeutic challenge in surgical oncology. The present thesis investigated the impact of body composition and immune and inflammatory-related biomarkers on oncologic and operative outcomes in patients with primary RPS underwent surgery for curative intent. In retrospective study were included total of 100 patients operated at Institute of Oncology in Ljubljana between 1999 and 2020. According to availability of preoperative computed tomography (CT) scans, study cohort was divided into 2 subgroups: one with CT scans (N = 58) and the other without. Using CT scans at the third lumbar vertebrae level, the preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT), and muscle radiation attenuation (MRA) were measured. To diagnose malnutrition the Global Leadership Initiative on Malnutrition (GLIM) criteria were used, whereas low muscle mass (myopenia) was defined based on updated European Working Group on Sarcopenia in Older People criteria. Furthermore, using the maximally selected log-rank statistics, optimal cohort-specific cut-off values for body composition parameters were investigated. Fearon et al. criteria from 2011 were used to define cachexia. Myosteatosis was defined based on a BMI-adjusted MRA cut-offs. After a median follow-up period of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) rates were 66.8 % and 77.6 %, respectively. Prevalence of malnutrition and cachexia was identical at 23.2 % of patients, while myopenia was detected in 33.3 %. Patients with preoperative malnutrition (log rank p = 0.035), myopenia (log rank p = 0.032) and cachexia (log rank p = 0.028) had a significantly lower 5-year OS. The skeletal muscle index and high subcutaneous adipose tissue index predicted LRFS in the univariate analysis (p = 0.052 and p = 0.039, respectively). Myosteatosis was linked to higher postoperative morbidity, but it was not correlated with OS and LRFS (p = 0.023). Lymphocyte to monocyte ratio (LMR) was the strongest inflammation-related prognostic biomarker, associated with OS (LMR ≤ 3 vs. LMR > 3, multivariate adjusted-HR 2.67, p = 0.027). Other immune and inflammation-related biomarkers did not yield sufficient evidence to be regarded as independent predictors in primary RPS. Based on research results we may conclude that preoperative body composition, nutrition disorders (malnutrition, cachexia), and nutrition related syndromes (myopenia, myosteatosis) and inflammation-related indices are important risk factors for survival and oncologic outcome in primary RPS.[M. Ramanović]20242024-12-12 13:30:12Doktorsko delo/naloga165872sl