A low psoas muscle volume correlates with a longer hospitalization after radical cystectomy

Abstract

BackgroundRecently, sarcopenia has been reported as a new predictor for patient outcomes or likelihood of post-operative complications. The purpose of this study was to evaluate the association of the psoas muscle volume with the length of hospitalization among patients undergoing radical cystectomy.MethodsA total of 63 (80.8%) male patients and 15 (19.2%) female patients who underwent radical cystectomy for their bladder cancer in our institution from 2000 to 2015 were analyzed. The psoas muscle index (PMI) was calculated by normalizing the psoas muscle area calculated using axial computed tomography at the level of the umbilicus (cm2) by the square of the body height (m2). Longer hospitalization was defined as hospitalization exceeding 30 days after surgery.ResultsThe median PMIs (mean ± standard deviation) were 391 (394 ± 92.1) and 271 (278 ± 92.6) cm2/m2 in men and women, respectively. Thus, the PMIs of male patients were significantly larger than those of females (p < 0.001). Based on the differences in gender, we analyzed 63 male patients for a further analysis. In male patients, those hospitalized longer showed a significantly smaller PMI than those normally discharged (377 ± 93.1 vs. 425 ± 83.4; p = 0.04). Similarly, male patients with a small PMI (<400) had a significantly worse overall survival (p = 0.02) than those with a large PMI (≥400).ConclusionsThe presence of sarcopenia was found to be associated with significantly longer hospitalization after radical cystectomy in male patients. Furthermore, in men, a PMI <400 may suggest a significantly worse prognosis.

Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer

“…The 5-year CSS and OS rates were lower for sarcopenic patients than for non-sarcopenic counterparts (49% vs. 72% for CSS and 39% vs. 70% for OS, respectively). Three studies from Japan reported similar results to those of Psutka et al [ 47 , 48 , 49 ]. Recently, a multi-center retrospective study from Germany demonstrated that sarcopenia is an independent predictor for both poorer CSS and OS in 500 bladder cancer patients undergoing a radical cystectomy [ 50 ].…”

“…As shown in Table 1 , six studies reported the prognostic role of sarcopenia in bladder cancer patients undergoing a radical cystectomy [ 45 , 46 , 47 , 48 , 49 , 50 ]. Five of them revealed that sarcopenia is a significant predictor of cancer-specific survival (CSS) and OS [ 46 , 47 , 48 , 49 , 50 ]. Psutka et al, for the first time demonstrated that sarcopenia is an independent predictor for both poorer CSS and OS [ 46 ].…”

A low psoas muscle volume predicts longer hospitalization and cancer recurrence in upper urinary tract urothelial carcinoma

“…There as well, a low PMI was associated with a poorer oncological outcome than a high PMI (9,10). Other recent studies have revealed that sarcopenia is a risk factor for postoperative complications or a poor survival in some solid cancers.…”

“…Although the detailed mechanisms underlying the association between sarcopenia and postoperative complications are still not fully understood, physical weakness reduces the persistence of long admissions of due to the adverse health effects of invasive surgery (10,13). Furthermore, sarcopenia is believed to develop due to aging or malignancy.…”

Sarcomatoid Variant of Bladder Carcinoma: A Case Report

“…Urinary bladder cancer is one of the most commonly diagnosed malignancies [ 1 ]. Two-thirds to three-fourths of patients with bladder tumor initially present with non-muscle-invasive (pTa or pT1) disease that can often be treated with conservative approaches; however, many patients suffer from recurrence, occasionally with grade and/or stage progression [ 2 ].…”