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The following is a summary of “Impact of CT-based adipose tissue distribution and sarcopenia on treatment outcomes in patients with high-risk soft tissue sarcoma,” published in the April 2025 issue of the BMC Cancer by Berclaz et al.

The prognostic significance of obesity and sarcopenia in patients with high-risk soft tissue sarcoma (HR-STS) remains insufficiently characterized, particularly in the context of multimodal preoperative treatment. This study aimed to investigate the relationship between CT-derived body composition metrics and clinical outcomes in patients with locally advanced, non-abdominal HR-STS undergoing preoperative chemotherapy combined with regional hyperthermia (RHT), with or without radiotherapy, followed by surgical resection.

A retrospective cohort of 85 patients treated between 2015 and 2022 was analyzed. All patients received preoperative chemotherapy and RHT, with some also receiving radiotherapy, prior to definitive surgery. Baseline CT scans were used to evaluate body composition parameters, including total fat index, fat-to-muscle ratio, and skeletal muscle index. These metrics were then correlated with event-free survival, overall survival, and both radiologic and histopathologic responses to preoperative therapy. Cox proportional hazards regression was employed to assess the association between body composition and survival outcomes.

CT-based body composition analysis revealed no statistically significant correlation between fat or muscle parameters and radiologic or histopathologic responses to preoperative therapy. However, increased adiposity was strongly associated with adverse survival outcomes. Specifically, patients with a high TFI demonstrated significantly worse OS ([HR] 3.56; p = 0.005), as did those with elevated FMR (HR 3.22; p = 0.020). Conversely, parameters indicative of sarcopenia, including the SMI, did not show a meaningful association with either OS or EFS. These findings suggest that fat distribution may be a more relevant prognostic factor than muscle mass in this clinical setting.

Excess total body fat and a high fat-to-muscle ratio are independent predictors of poor overall survival in patients with high-risk soft tissue sarcoma undergoing multimodal preoperative treatment. While muscle depletion alone did not correlate with clinical outcomes, adiposity-related metrics demonstrated strong prognostic value. These findings underscore the importance of body composition profiling as a non-invasive prognostic tool and support further investigation into its utility for treatment stratification. Larger prospective studies are needed to validate these associations and explore whether targeted interventions for obesity could improve outcomes in this patient population.

Source: bmccancer.biomedcentral.com/articles/10.1186/s12885-025-14050-x