Sarcopenia as a Prognostic Biomarker of Advanced Urothelial Carcinoma

Abstract

ObjectivesSarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients.MethodsThis retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm2/m2 for males with body mass index (BMI) <25 cm2/m2, <53 cm2/m2 for males with BMI ≥25 cm2/m2, and <41 cm2/m2 for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models.ResultsSixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, P <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (P <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, P <0.001), along with higher C-reactive protein (CRP) (P = 0.001), upper urinary tract cancer (P = 0.007), higher lactate dehydrogenase (LDH) (P = 0.047), and higher alkaline phosphatase (ALP) (P = 0.048).ConclusionSarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.

Sarcopenia in Advanced Serous Ovarian Cancer

“…An association between sarcopenia and survival has also been described for other solid malignancies including gastrointestinal, biliary tract, lung, urothelial, colorectal, pancreatic, and metastatic breast cancer. 6,8,12,14,34,35 Other studies showed a correlation of sarcopenia and therapyinduced adverse effects. 8,30,36 We used the cutpoint of 38.5 cm 2 /m 2 for sarcopenia that was proposed by Prado et al 6 As a matter of fact, this cutpoint resulted in the best stratification in terms of predicting survival also in our analysis.…”

Association of Weight Change after Colorectal Cancer Diagnosis and Outcomes in the Kaiser Permanente Northern California Population

“…Adequate muscle mass, and possibly greater muscle mass than noncancer patients, has been shown to be a strong determinant of overall mortality in several studies of cancer patients. (28-39) Studies of CRC patients with advanced disease found that muscle wasting was associated with worse recurrence-free and/or overall survival(40) as well as poor response to chemotherapy. (41) Persons with low muscle mass experience elevated low-grade systemic inflammation,(42) and altered mitochondrial function,(43, 44) both of which may influence cancer progression .…”

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients

“…Sarcopenia, either on its own or as a central component of cachexia, is defined as muscle depletion “two standard deviations below the mean of a young reference group” [5]. In studies with cancer of the gastrointestinal-tract (GI), breast cancer and lung cancer, sarcopenia was associated with poor survival [4, 6–10]. Moreover, sarcopenia is associated with higher rates of chemotherapy-induced toxicity [11, 12].…”