Hideyuki Abe1, Kohei Takei2, Toshitaka Uematsu2, Yuumi Tokura2, Issei Suzuki2, Kazumasa Sakamoto2, Daisaku Nishihara3, Yoshiyuki Yamaguchi2, Tomoya Mizuno4, Akinori Nukui2, Minoru Kobayashi5, Takao Kamai2. 1. Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Shimotsuga, Tochigi, 321-0293, Japan. h-abe@dokkyomed.ac.jp. 2. Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Shimotsuga, Tochigi, 321-0293, Japan. 3. Department of Urology, Yuai Memorial Hospital, 707 Higashiushigaya, Koga, Ibaraki, 306-0232, Japan. 4. Department of Urology, Nasu Red Cross Hospital, 1081-4, Nakatawara, Ootawara, Tochigi, 324-8686, Japan. 5. Department of Urology, Utsunomiya Memorial Hospital, 1-3-16 Ohdoori, Utsunomiya, Tochigi, 320-0811, Japan.
Abstract
BACKGROUND: Recently, numerous studies have reported an association between sarcopenia and poor outcomes in various kinds of malignancies. We investigated whether sarcopenia predicts the survival of patients with metastatic urothelial carcinoma who underwent systemic chemotherapy. METHODS: We reviewed 87 metastatic urothelial carcinoma patients who underwent chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin for cisplatin-unfit patients) between 2007 and 2015. A computed tomography scan prior to chemotherapy was used for evaluating sarcopenia, and we measured three cross-sectional areas of skeletal muscle at the third lumbar vertebra and calculated the skeletal muscle index (SMI), the paraspinal muscle index (PSMI), and the total psoas area (TPA) of each patient. Predictive values of survival were assessed using Cox regression analysis. RESULTS: The median overall survival (OS) was 16 months (95% CI 13.5-18). Although SMI alone was not a significant predictor of shorter OS (P = 0.117) in univariate analysis, SMI stratified by the value of the body mass index (BMI) was a significant predictor of shorter OS in univariate analysis (P = 0.037) and was also an independent predictor of shorter OS in multivariate analysis (P = 0.026). PSMI and TPA were not significant prognostic factors even when stratified by BMI (P = 0.294 and 0.448), respectively. CONCLUSION: Neither PSMI nor TPA could substitute SMI as a predictor for poor outcomes in metastatic urothelial carcinoma patients treated with systemic chemotherapy in our study. SMI stratified by BMI is a useful predictor of prognosis in these patients.
BACKGROUND: Recently, numerous studies have reported an association between sarcopenia and poor outcomes in various kinds of malignancies. We investigated whether sarcopenia predicts the survival of patients with metastatic urothelial carcinoma who underwent systemic chemotherapy. METHODS: We reviewed 87 metastatic urothelial carcinomapatients who underwent chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin for cisplatin-unfit patients) between 2007 and 2015. A computed tomography scan prior to chemotherapy was used for evaluating sarcopenia, and we measured three cross-sectional areas of skeletal muscle at the third lumbar vertebra and calculated the skeletal muscle index (SMI), the paraspinal muscle index (PSMI), and the total psoas area (TPA) of each patient. Predictive values of survival were assessed using Cox regression analysis. RESULTS: The median overall survival (OS) was 16 months (95% CI 13.5-18). Although SMI alone was not a significant predictor of shorter OS (P = 0.117) in univariate analysis, SMI stratified by the value of the body mass index (BMI) was a significant predictor of shorter OS in univariate analysis (P = 0.037) and was also an independent predictor of shorter OS in multivariate analysis (P = 0.026). PSMI and TPA were not significant prognostic factors even when stratified by BMI (P = 0.294 and 0.448), respectively. CONCLUSION: Neither PSMI nor TPA could substitute SMI as a predictor for poor outcomes in metastatic urothelial carcinomapatients treated with systemic chemotherapy in our study. SMI stratified by BMI is a useful predictor of prognosis in these patients.
Entities:
Keywords:
Body mass index; Chemotherapy; Muscle area; Prognosis; Sarcopenia; Urothelial carcinoma
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