Clinical Impact of Sarcopenia and Inflammatory/Nutritional Markers in Patients with Unresectable Metastatic Urothelial Carcinoma Treated with Pembrolizumab

Abstract

Sarcopenia is a muscle loss syndrome known as a risk factor of various carcinomas. The impact of sarcopenia and sarcopenia-related inflammatory/nutritional markers in metastatic urothelial carcinoma (mUC) treated with pembrolizumab was unknown, so this retrospective study of 27 patients was performed. Psoas muscle mass index (PMI) was calculated by bilateral psoas major muscle area at the L3 with computed tomography. The cut-off PMI value for sarcopenia was defined as ≤6.36 cm2/m2 for men and ≤3.92 cm2/m2 for women. Neutrophil-to-lymphocyte ratio (NLR) ≥ 4.0 and sarcopenia correlated with significantly shorter progression-free survival (PFS) (hazard ratio (HR) 3.81, p = 0.020; and HR 2.99, p = 0.027, respectively). Multivariate analyses identified NLR ≥ 4.0 and sarcopenia as independent predictors for PFS (HR 2.89, p = 0.025; and HR 2.79, p = 0.030, respectively). Prognostic nutrition index < 45, NLR ≥ 4.0 and sarcopenia were correlated with significantly worse for overall survival (OS) (HR 3.44, p = 0.046; HR 4.26, p = 0.024; and HR 3.92, p = 0.012, respectively). Multivariate analyses identified sarcopenia as an independent predictor for OS (HR 4.00, p = 0.026). Furthermore, a decrease in PMI ≥ 5% in a month was an independent predictor of PFS and OS (HR 12.8, p = 0.008; and HR 6.21, p = 0.036, respectively). Evaluation of sarcopenia and inflammatory/nutritional markers may help in the management of mUC with pembrolizumab.

Response Prediction in Immune Checkpoint Inhibitor Immunotherapy for Advanced Hepatocellular Carcinoma

“…The patients with NLR ˂ 5 had a better tumor response than the patients with NLR ≥ 5 [ 26 ]. NLR could also be recognized as predictors of ICI therapy in other cancers [ 27 , 28 , 29 , 30 ]. In this study, the patients with NLR ≤ 2.5 prior to ICI treatment had a better chance of disease-control.…”

Prognostic Nutritional Index Predicts Toxicity in Head and Neck Cancer Patients Treated with Definitive Radiotherapy in Association with Chemotherapy

“…Among the biomarkers of systemic inflammation, the prognostic nutritional index (PNI) is calculated by combining the circulating albumin concentration with the lymphocyte count. Therefore, PNI has also been recognized as an accurate parameter reflecting nutritional and inflammation status [ 19 ]. In the last few years, PNI has been extensively investigated as predictor of poor outcome in several types of cancer [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], including HNC [ 31 , 32 , 33 , 34 ].…”

Prognostic Significance of the Albumin-to-globulin Ratio for Advanced Urothelial Carcinoma Treated with Pembrolizumab: A Multicenter Retrospective Study

“…Among biomarkers of patients with UC, the neutrophil-to-lymphocyte ratio (NLR) [7] is a well-established marker in patients with advanced UC [8][9][10][11][12][13], including those treated with pembrolizumab [9][10][11][12][13]. Similarly, the albumin-to-globulin ratio (AGR) is an established marker in oncology [14][15][16][17][18][19][20][21][22][23][24].…”