Sarcopenia in patients with bladder cancer undergoing radical cystectomy: Impact on cancer‐specific and all‐cause mortality

Abstract

BACKGROUND:The authors evaluated sarcopenia as a predictor of cancer-specific survival (CSS) and overall survival (OS) among patients with urothelial cancer of the bladder undergoing radical cystectomy (RC). METHODS: The lumbar skeletal muscle index (SMI) of 205 patients treated with RC for urothelial cancer between 2000 and 2007 was measured. Sarcopenia was classified according to international consensus definitions (SMI of < 55 cm 2 /m 2 for men and < 39 cm 2 /m 2 for women). The CSS and OS were estimated using the Kaplan-Meier method and compared with the log-rank test. Variables associated with CSS and all-cause mortality were summarized with hazard ratios (HRs). RESULTS: Of 205 patients, 141 (68.8%) were sarcopenic. Patients with sarcopenia were older, but were otherwise similar to patients without sarcopenia with respect to sex, Charlson comorbidity index, American Society of Anesthesiologists score, Eastern Cooperative Oncology Group performance status, receipt of neoadjuvant chemotherapy, TNM stage of disease, and tumor grade (P >.05 for all). The median follow-up was 6.7 years, during which time 135 patients died, including 91 who died of bladder cancer. Sarcopenic patients had significantly worse 5-year CSS (49% vs 72%; P 5.003) and OS (39% vs 70%; P 5.003) compared with patients without sarcopenia. Moreover, sarcopenia was found to be independently associated with both increased CSS (HR, 2.14; P 5.007) and all-cause mortality (HR, 1.93; P 5.004) on multivariable analysis. CONCLUSIONS: The presence of sarcopenia was found to significantly increase a patient's risk of CSS and all-cause mortality after undergoing RC for bladder cancer.

Impact of body mass index on the oncological outcomes of patients treated with radical cystectomy for muscle-invasive bladder cancer

“…Heterogeneity in lymph node dissection and lack of data on variant histology are both limitations to our data analysis we are aware of. Some of the more recent studies reported almost 70 % of patients selected for RC for a muscle-invasive bladder carcinoma were sarcopenic [20,21]. Those patients had a worse prognosis than the others, and sarcopenia was an independent prognostic factor , but further studies should consider evaluating sarcopenia and cancer-specific survival since it might be a confusing factor in our cohort.…”

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

“…Sarcopenia and myosteatosis have been significantly associated with a range of adverse outcomes including increased rate of post‐operative complications,10, 11, 40, 41, 42 longer length of hospital stay,41, 43 30‐day post‐operative mortality and in‐hospital mortality,44 and dose‐limiting toxicities 5, 6, 7, 8, 45, 46, 47, 48, 49, 50. In addition, the conditions have been demonstrated as independent predictors of reduced overall survival 18, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64. The situation is further complicated by the obesity epidemic that has been progressively worsening in recent times.…”

Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy

“…9, 10 A previous report indicated a close relationship between nutrition and sarcopenia, 11 but to date there has not been a report on the association between malnutrition and P eripheral artery disease (PAD) is a part of the systemic atherothrombosis that is highly concomitant with cerebrocardiovascular diseases. 1 Despite advancing medical therapy and endovascular therapy (EVT), PAD remains an important condition resulting in poor patient quality of life and high all-cause and cardiovascular mortality rates.…”