Sarcopenia and modified Glasgow Prognostic Score predict postsurgical outcomes in localized renal cell carcinoma

Abstract

BACKGROUND: Body composition and inflammation are gaining importance for prognostication in cancer. This study investigated the individual and combined utility of the preoperative skeletal muscle index (SMI) and the modified Glasgow Prognostic Score (mGPS) for estimating postoperative outcomes in patients with localized renal cell carcinoma (RCC) undergoing nephrectomy. METHODS: The authors performed a retrospective review of 352 patients with localized RCC. SMI was measured via computed tomography or magnetic resonance imaging. Patients met the criteria for sarcopenia by body mass index-and sex-stratified thresholds. Multivariable and Kaplan-Meier analyses of associations of sarcopenia and mGPS with overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were performed. Variables were analyzed independently and combined into risk groups: low risk (nonsarcopenic, low mGPS), medium risk (sarcopenia only), medium risk (inflammation only), and high risk (sarcopenic, high mGPS). Receiver operating characteristic (ROC) curves were used to analyze risk groups in comparison with the Stage, Size, Grade, and Necrosis (SSIGN) score and the modified International Metastatic RCC Database Consortium (IMDC) score. RESULTS: The majority of the patients were at stage pT3 (63%), 39.5% of the patients were sarcopenic, and 19.3% had an elevated mGPS at the baseline. The median follow-up time was 30.4 months. Sarcopenia and mGPS were independently associated with worse OS (hazard ratio for sarcopenia, 1.64; P = .006; hazard ratio for mGPS, 1.72; P = .012), CSS, and RFS. Risk groups had an increasing association with worse RFS (P = .015) and CSS (P = .004) but not OS (P = .087). ROC analyses demonstrated a higher area under the curve for risk groups in comparison with the SSIGN and IMDC scores at 5 years. CONCLUSIONS: Sarcopenia and an elevated mGPS were associated with worse clinical outcomes in this study of patients with localized RCC. This has implications for preoperative prognostication and treatment decision-making.

Let's ask the patient: Self‐reported quality‐of‐life measures help to predict kidney cancer mortality

“…5,6 In addition, there are several quantifiable instruments such as sarcopenia and the Eastern Cooperative Oncology Group performance status that can measure physical health to some extent. Sarcopenia has been found to be associated with worse survival in patients with localized renal cell carcinoma, 7 and this is in line with the current article. These measures of physical health can be compared with self-reported QOL metrics in prospective studies to help to define the predictive value of each instrument.…”

Muscle Mass Matters in Patients with Renal Cell Carcinoma, but That Is Only the Beginning…

“…As the authors state, findings show that deficiencies in muscle mass are independently associated with relevant short-term clinical outcomes (complications, functional deficits, systemictherapy-associated adverse events) and long-term clinical outcomes (cancer-specific and all-cause mortality) across malignancies. [7][8][9] These results are consistent with those from prior cohorts of patients with localized RCC (pT1-4 Nx/0) 10,11 treated surgically and those from patients with metastatic RCC treated with cytoreductive nephrectomy. 12 Other authors have observed an association between sarcopenia and postoperative surgical complications, but not overall survival.…”

“…15 Second, the relationships between observations of muscle loss and potentially additive risk factors such as malnutrition, low activity, and multimorbidity remain to be fully characterized, as well as key outcomes beyond survival such as physical function, independence, cognition, and quality of life. 11,16,17 Finally, numerous outstanding methodologic questions are saliant for the continued pursuit of high-quality body composition research. One key knowledge gap is associated with the need to describe robust population-based body composition norms across racial and ethnic groups, ages, and disease states.…”

Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

“…Our findings expand the evidence relating muscle mass to cancer‐specific survival. The muscle area on abdominal CT at the level of the third lumbar vertebral body is an established predictor of cancer‐specific survival following resection of infra‐diaphragmatic malignancies 24–28 . Psoas muscle area on preoperative abdominal CT has also been linked to OS in patients with lung cancer in a single‐center study 12 .…”