Sarcopenia as a comorbidity‐independent predictor of survival following radical cystectomy for bladder cancer

Abstract

BackgroundA multicentre study was conducted to investigate the impact of sarcopenia as an independent predictor of oncological outcome after radical cystectomy for bladder cancer.MethodsIn total, 500 patients with available digital computed tomography scans of the abdomen obtained within 90 days before surgery were identified. The lumbar skeletal muscle index was measured using pre‐operative computed tomography. Cancer‐specific survival (CSS) and overall survival (OS) were estimated using Kaplan–Meier curves. Predictors of CSS and OS were analysed by univariable and multivariable Cox regression models.ResultsBased on skeletal muscle index, 189 patients (37.8%) were classified as sarcopenic. Patients with sarcopenia were older compared with their counterparts (P = 0.002), but both groups were comparable regarding to gender, comorbidity, tumor, node, metastasis (TNM) stage, and type of urinary diversion (all P > 0.05). In total, 234 (46.8%) patients died, and of these, 145 (29.0%) died because of urothelial carcinoma of the bladder. Sarcopenic patients had significantly worse 5 year OS (38.3% vs. 50.5%; P = 0.002) and 5 year CSS (49.5% vs. 62.3%; P = 0.016) rates compared with patients without sarcopenia. Moreover, sarcopenia was associated independently with both increased all‐cause mortality (hazard ratio, 1.43; 95% confidence interval 1.09–1.87; P = 0.01) and increased cancer‐specific mortality (hazard ratio, 1.42; 95% confidence interval, 1.00–2.02; P = 0.048). Our results are limited by the lack of prospective frailty assessment.ConclusionsSarcopenia has been shown to be an independent predictor for OS and CSS in a large multicentre study with patients undergoing radical cystectomy for bladder cancer.

Feasibility and outcomes of selective tetramodal bladder‐preservation therapy in elderly patients with muscle‐invasive bladder cancer

“…Sarcopenia is another clinical predictor of postoperative complications after RC . In addition to its association with surgical complications, sarcopenia, which was defined according to the Martin criteria in the present study, is an independent prognostic factor for survival after RC . In the present study, 54% of patients with pre‐treatment CT images were classified as having sarcopenia.…”

“…9,10 In addition to its association with surgical complications, sarcopenia, which was defined according to the Martin criteria 23 in the present study, is an independent prognostic factor for survival after RC. 28 In the present study, 54% of patients with pre-treatment CT images were classified as having sarcopenia. The prevalence of sarcopenic patients was higher than that reported in previous studies on RC, suggesting that TeMT was more commonly utilized in patients who were considered unfit for RC.…”

Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer

“…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 ].…”

Einfluss der radikalen Zystektomie auf die Lebensqualität und Strategien für deren Erhalt

“…Prähabilitation kann durch frühzeitiges Assessment des Patienten erfasst werden, um Gebrechlichkeitsfaktoren zu identifizieren, wie z. B. Sarkopenie, aber auch Eisenmangelanämie oder Polypharmazie mit Medikationsfehlern, die in einer präoperativen Phase von 4 -6 Wochen verbessert werden können [3]. Zur präoperativen Vorbereitungsphase nach ERAS gehören daher Ernährungs-und Bewegungsprogramme sowie ggf.…”