Simple SummaryFive-year overall survival in patients with epithelial ovarian cancer is still set at 50%, going down to 31% in patients presenting with advanced stage disease. Recent studies have shown associations between some body composition values, such as sarcopenia, and overall survival in ovarian cancer patients, but the results are still conflicting. The main aim of this retrospective exploratory study was to assess the associations between many body composition components, extracted from computed tomography performed in routine clinical practice, and overall survival and progression-free survival. Extended body composition evaluation confirmed an association between body composition components (skeletal muscle volume) and overall survival and progression-free survival, as well as associations between intramuscular adipose tissue, epicardial adipose tissue and paracardial adipose tissue with progression-free survival. These promising results encourage further studies assessing the role of body composition in outcomes of ovarian cancer patients.AbstractBackground: The primary objective of this study was to assess the associations of computed tomography (CT)-based whole-body composition values with overall survival (OS) and progression-free survival (PFS) in epithelial ovarian cancer (EOC) patients. The secondary objective was the association of body composition with chemotherapy-related toxicity. Methods: Thirty-four patients (median age 64.9 years; interquartile range 55.4–75.4) with EOC and thorax and abdomen CT scans were included. Clinical data recorded: age; weight; height; stage; chemotherapy-related toxicity; and date of last contact, progression and death. Automatic extraction of body composition values was performed by dedicated software. Sarcopenia was defined according to predefined cutoffs. Statistical analysis included univariate tests to investigate associations of sarcopenia and body composition with chemotoxicity. Association of body composition parameters and OS/PFS was evaluated by log-rank test and Cox proportional hazard model. Multivariate models were adjusted for FIGO stage and/or age at diagnosis. Results: We found significant associations of skeletal muscle volume with OS (p= 0.04) and PFS (p= 0.04); intramuscular fat volume with PFS (p= 0.03); and visceral adipose tissue, epicardial and paracardial fat with PFS (p= 0.04, 0.01 and 0.02, respectively). We found no significant associations between body composition parameters and chemotherapy-related toxicity. Conclusions: In this exploratory study, we found significant associations of whole-body composition parameters with OS and PFS. These results open a window to the possibility to perform body composition profiling without approximate estimations.