Impact of sarcopenia in bladder preservation therapy for muscle-invasive bladder cancer patients: a narrative review

Abstract

Background and Objectives: Muscle-invasive bladder cancer (MIBC) is a biologically aggressive disease and its prognosis is poor. Radical cystectomy (RC) with urinary diversion and lymph node dissection is the gold standard treatment for MIBC patients. Accumulating evidence indicates that sarcopenia, the degenerative and systemic loss of skeletal muscle mass, is a significant predictor of higher rates of mortality and perioperative complications following RC. Recently, bladder preservation therapy has been offered as an alternative in appropriately selected MIBC patients who desire to preserve their bladders and those unfit or unwilling for RC. Here, we performed a narrative review on the impact of sarcopenia on oncological outcomes and complication rates in MIBC patients treated with bladder preservation therapy.Methods: A literature review was performed using the PubMed and Scopus databases.

Predictive role of pretreatment skeletal muscle mass index for long-term survival of bladder cancer patients: A meta-analysis

“…Bladder cancer patients may experience malnutrition due to the impact of the tumor on the body's metabolism and absorption, or due to adverse reactions during treatment, such as loss of appetite, nausea, and vomiting. Besides, bladder cancer patients with sarcopenia may have reduced tolerance to surgical and chemotherapeutic treatments, and the disruption of the body's immune and metabolic functions may interfere with the normal response to these treatments [33]. In the past years, the association between sarcopenia and prognosis in cancers has been widely reported and revealed.…”

Immunonutrition in Radical Cystectomy: State of the Art and Perspectives

“…In murine models, the administration of FOLFIRI (5-FU, leucovorin, irinotecan) and FOLFOX (5-FU, leucovorin, oxaliplatin) leads to weight loss, adipose tissue loss, skeletal muscle wasting, weakness, and involves mechanisms such as the hyperactivation of catabolic signaling pathways, sarcomere structural changes, and the depletion of muscle mitochondria [17,18]. Although one study demonstrated that skeletal muscle change during neoadjuvant chemotherapy prior to RC is an independent predictor of ileus, infection, and other complications [19], conclusive data on the impact of sarcopenia in MIBC patients are not available due to limited evidence [20]. Conversely, the loss of skeletal muscle in metastatic urothelial bladder carcinoma has been demonstrated to be a significant predictor of 90-day mortality and postoperative complications [21].…”