Sarcopenia as a Predictor of Complications and Survival Following Radical Cystectomy

No AccessJournal of UrologyAdult Urology1 Jun 2014Sarcopenia as a Predictor of Complications and Survival Following Radical Cystectomy Angela B. Smith, Allison M. Deal, Hyeon Yu, Brian Boyd, Jonathan Matthews, Eric M. Wallen, Raj S. Pruthi, Michael E. Woods, Hyman Muss, and Matthew E. Nielsen Angela B. SmithAngela B. Smith Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Allison M. DealAllison M. Deal Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Hyeon YuHyeon Yu Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Brian BoydBrian Boyd Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Jonathan MatthewsJonathan Matthews Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Eric M. WallenEric M. Wallen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with MDx Health. More articles by this author , Raj S. PruthiRaj S. Pruthi Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Michael E. WoodsMichael E. Woods Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with LabCorp. More articles by this author , Hyman MussHyman Muss Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Geriatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , and Matthew E. NielsenMatthew E. Nielsen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.12.047AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients undergoing radical cystectomy face substantial but highly variable risks of major complications. Risk stratification may be enhanced by objective measures such as sarcopenia. Sarcopenia (loss of skeletal muscle mass) has emerged as a novel biomarker associated with adverse outcomes in many clinical contexts relevant to cystectomy. Based on these data we hypothesized that sarcopenia would be associated with increased 30-day major complications and mortality after radical cystectomy for bladder cancer. Materials and Methods: We performed a retrospective study of patients treated with radical cystectomy at our institution from 2008 to 2011. Sarcopenia was assessed by measuring cross-sectional area of the psoas muscle (total psoas area) on preoperative computerized tomography. Cutoff points were developed and evaluated using ROC curves to determine predictive ability in men and women for outcomes of major complications and survival. Results: Of 224 patients with bladder cancer 200 underwent preoperative computerized tomography within 1 month of surgery. Total psoas area was calculated with a mean score of 712 and 571 cm2/m2 in men and women, respectively. A clear association was noted between major complications and lower total psoas area in women using a cutoff of 523 cm2/m2 to define sarcopenia (AUC 0.70). Sarcopenia was not significantly associated with complications in men. There was a nonsignificant trend of sarcopenia with worse 2-year survival. Conclusions: Sarcopenia in women was a predictor of major complications after radical cystectomy. Further research confirming sarcopenia as a useful predictor of complications would support the development of targeted interventions to mitigate the untoward effects of sarcopenia before cancer surgery. References 1 : Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol2009; 56: 443. Google Scholar 2 : Complications of radical cystectomy for carcinoma of the bladder. J Urol1980; 123: 640. Link, Google Scholar 3 : Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol2002; 167: 2012. Link, Google Scholar 4 : Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?. BJU Int2009; 104: 986. 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Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAlbersheim J, Sathianathen N, Zabell J, Renier J, Bailey T, Hanna P, Konety B and Weight C (2019) Skeletal Muscle and Fat Mass Indexes Predict Discharge Disposition after Radical CystectomyJournal of Urology, VOL. 202, NO. 6, (1143-1149), Online publication date: 1-Dec-2019.Pak S, Park S, Shin T, You D, Jeong I, Hong J, Kim C and Ahn H (2019) Association of Muscle Mass with Survival after Radical Prostatectomy in Patients with Prostate CancerJournal of Urology, VOL. 202, NO. 3, (525-532), Online publication date: 1-Sep-2019.Ritch C, Cookson M, Clark P, Chang S, Fakhoury K, Ralls V, Thu M, Penson D, Smith J and Silver H (2019) Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled TrialJournal of Urology, VOL. 201, NO. 3, (470-477), Online publication date: 1-Mar-2019.Lee J, Lee H, Ha J, Han K, Rha K, Hong S, Chung B and Koo K (2018) Subcutaneous Fat Distribution is a Prognostic Biomarker for Men with Castration Resistant Prostate CancerJournal of Urology, VOL. 200, NO. 1, (114-120), Online publication date: 1-Jul-2018.Michalak J, Lin F and Twiss C (2016) Review Article: Preoperative Evaluation and Optimization of the Geriatric Urological PatientUrology Practice, VOL. 4, NO. 6, (499-507), Online publication date: 1-Nov-2017.Griebling T (2017) Re: Frailty and Post-Operative Outcomes in Older Surgical Patients: A Systematic ReviewJournal of Urology, VOL. 198, NO. 2, (229-230), Online publication date: 1-Aug-2017.Sharma P, Henriksen C, Zargar-Shoshtari K, Xin R, Poch M, Pow-Sang J, Sexton W, Spiess P and Gilbert S (2015) Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical CystectomyJournal of Urology, VOL. 195, NO. 1, (47-52), Online publication date: 1-Jan-2016.Griebling T (2015) Re: Can Routine Preoperative Data Predict Adverse Outcomes in the Elderly? 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Smith Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Allison M. Deal Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Hyeon Yu Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Brian Boyd Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Jonathan Matthews Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Eric M. Wallen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with MDx Health. More articles by this author Raj S. Pruthi Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Michael E. Woods Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with LabCorp. More articles by this author Hyman Muss Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Geriatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Matthew E. Nielsen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Expand All Advertisement PDF downloadLoading ...