Journal
JOURNAL OF UROLOGY
Volume 191, Issue 6, Pages 1714-1720Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1016/j.juro.2013.12.047
Keywords
urinary bladder neoplasms; cystectomy; sarcopenia; postoperative complications; prognosis
Categories
Funding
- University Cancer Research Fund
- National Center for Research Resources
- National Center for Advancing Translational Sciences, National Institutes of Health [KL2TR000084]
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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 cm(2)/m(2) 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 cm(2)/m(2) 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.
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