Sarcopenia as a Novel Preoperative Prognostic Predictor for Survival in Patients with Bladder Cancer Undergoing Radical Cystectomy

Hirasawa, Yosuke; Nakashima, Jun; Yunaiyama, Daisuke; Sugihara, Toru; Gondo, Tatsuo; Nakagami, Yoshihiro; Horiguchi, Yutaka; Ohno, Yoshio; Namiki, Kazunori; Ohori, Makoto; Tokuuye, Koichi; Tachibana, Masaaki

doi:10.1245/s10434-016-5606-4

Cited by 75 publications

(84 citation statements)

References 29 publications

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“…The NLR data were collected before surgery or chemotherapy in the included studies. The cut-off values for the NLR ranged from 2 to 5, and the cut-off value was not specified in 3 studies [15, 35, 38]. In Mano’s study, there were two cut-off values, one each to evaluate the prognostic role of the NLR in progression-free survival (PFS) and relapse-free survival (RFS) [31].…”

Section: Resultsmentioning

confidence: 99%

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

Zhao

Wang

et al. 2018

Cell Physiol Biochem

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Background/Aims: Emerging studies have shown that the neutrophil-lymphocyte ratio (NLR) is a potential predictor in various tumors. Our study was conducted to assess the prognostic value of the pretreatment NLR in bladder cancer and metastatic or unresectable urothelial carcinoma (mUC or uUC) patients up to July 2017. The correlation between the pretreatment NLR and pathological characteristics was also evaluated in bladder cancer patients. Methods: The hazard ratio (HR) and odds ratio (OR) with the 95% confidence interval (CI) were extracted or calculated from the included studies for further pooled analysis. A total of 21 studies were included in a pooled analysis. Results: The pooled results indicated that a high pretreatment NLR was associated with reduced overall survival (OS) (HR=1.27, 95% CI=1.12-1.43), relapse-free survival (RFS) (HR=1.41, 95% CI=1.23-1.60), progression-free survival (PFS) (HR=1.75, 95% CI=1.36-2.15), disease-specific survival (DSS) and cancer-specific survival (CSS) (HR=1.27, 95% CI=1.19-1.35) in the bladder cancer patients. Additionally, an elevated pretreatment NLR suggested a worse OS rate in the mUC or uUC patients (HR=1.63, 95% CI=1.34-1.91). The pooled ORs and 95% CIs showed that a high pretreatment NLR could be a risk indicator for certain pathological features, such as lymphovascular invasion, a positive margin status and advanced tumor stage. Conclusions: our results showed that a high pretreatment NLR predicted poor prognosis in bladder cancer, mUC and uUC patients.

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Section: Resultsmentioning

confidence: 99%

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

Zhao

Wang

et al. 2018

Cell Physiol Biochem

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“…Although numerous studies have evaluated single biomarkers or combinations of several biomarkers [4,5,24] , no studies have evaluated numerous integrated markers in a single cohort. In addition, the present study evaluated two nutritional indexes (PNI and CONUT score), based on the scarcity of data regarding the clinical relevance of pretreatment nutritional status.…”

Section: Discussionmentioning

confidence: 99%

“…As mGPS reflects the serum levels of CRP and albumin, this score is linked to both inflammation and nutritional status. Previous reports regarding the relationship between pretreatment factors and prognosis in MIBC cases have only investigated inflammation-based markers [4,5,24] and have not considered nutrition and muscle indexes. Our results imply that increased systemic inflammation may lead to increases in PNI and PMI, and subsequently to cachexia.…”

Section: Discussionmentioning

confidence: 99%

Integrative Assessment of Pretreatment Inflammation-, Nutrition-, and Muscle-Based Prognostic Markers in Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy

Miyake¹,

Morizawa²,

Hori³

et al. 2017

Oncology

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Objective: The present study evaluated the clinical relevance of an integrative preoperative assessment of inflammation-, nutrition-, and muscle-based markers for patients with muscle-invasive bladder cancer (MIBC) undergoing curative radical cystectomy (RC). Methods: The analysis enrolled 117 patients and the variables included age, body mass index (BMI), neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, modified Glasgow Prognostic Score (mGPS), prognostic nutritional index (PNI), Controlling Nutritional Status score, psoas muscle index (PMI), and peak expiratory flow (PEF). The correlations among the variables were evaluated and their prognostic values after RC were tested. Results: Three inflammation markers (ratios of blood cell counts) were positively correlated (p < 0.0001). The PNI and the BMI were positively correlated (p = 0.04), although they were inversely correlated with the three inflammation markers (p < 0.0001). Age was not significantly correlated with the inflammation markers and PMI, although older age was associated with lower PNI and lower PEF. The disease-specific survival was independently predicted by T4 tumor, positive N status, and decreased PNI. Overall survival was independently predicted by T4 tumor, mGPS, and pretreatment sarcopenia status. Conclusions: The inflammation-, nutrition-, and muscle-based markers would be useful risk assessment tools for MIBC.

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“…Furthermore, sarcopenia has been shown to be an independent prognostic factor of survival after RC for UCB, and it was strongly associated with early complications following RC . However, only single‐centre studies with limited patient numbers or inadequate sarcopenia classifications are available …”

Section: Introductionmentioning

confidence: 99%

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

Mayr

Gierth

Zeman

et al. 2018

J cachexia sarcopenia muscle

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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.

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Sarcopenia as a Novel Preoperative Prognostic Predictor for Survival in Patients with Bladder Cancer Undergoing Radical Cystectomy

Abstract: Sarcopenia, clinical T stage, presence of hydronephrosis, histology of TURBT specimen, and NLR are novel preoperative prognostic factors even after adjustment for other known preoperative predictors in patients undergoing RC for bladder cancer.

Cited by 75 publications

References 29 publications

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

Integrative Assessment of Pretreatment Inflammation-, Nutrition-, and Muscle-Based Prognostic Markers in Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy

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

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