Fukushima Hiroshi, Nakanishi Yasukazu, Kataoka Madoka, Tobisu Ken-Ichi, Koga Fumitaka
Department of Urology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome Bunkyo-ku, Tokyo, 113-8677, Japan.
Cancer Med. 2016 Sep;5(9):2213-20. doi: 10.1002/cam4.795. Epub 2016 Jun 28.
We investigated the prognostic significance of sarcopenia in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). The skeletal muscle index (SMI) was calculated from computed tomography images. Sarcopenia was defined as SMI <43 cm(2) /m(2) for males with body mass index <25 kg/m(2) , <53 cm(2) /m(2) for males with BMI ≥25 kg/m(2) , and <41 cm(2) /m(2) for females. Associations of sarcopenia with cancer-specific survival (CSS) and overall survival (OS) were evaluated in 81 consecutive UTUC patients who underwent RNU. Forty-seven (58%) out of 81 patients had sarcopenia. Multivariate analyses identified sarcopenia as a significant and independent poor prognostic factor for both CSS (hazard ratio [HR] 8.58, 95% confidence interval [CI]: 1.63-158.1, P = 0.008) and OS (HR 6.05, 95%CI 2.00-26.21, P < 0.001). In patients with locally advanced disease (pT3/4 or pN+), those with sarcopenia showed significantly worse CSS and OS than those without (5-year CSS rate 55% vs. 100%, P = 0.014; 5-year OS rate 40% vs. 86%, P = 0.007). In contrast, no prognostic difference was observed between patients with and without sarcopenia in those with organ-confined disease (pTa-2pN0/x). Sarcopenia is an independent poor prognostic factor for UTUC patients treated with RNU, particularly for those with locally advanced disease.
我们研究了接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC）患者中肌肉减少症的预后意义。通过计算机断层扫描图像计算骨骼肌指数（SMI）。肌肉减少症的定义为：体重指数（BMI）<25kg/m²的男性，SMI<43cm²/m²；BMI≥25kg/m²的男性，SMI<53cm²/m²；女性SMI<41cm²/m²。在81例连续接受RNU的UTUC患者中评估了肌肉减少症与癌症特异性生存（CSS）和总生存（OS）的相关性。81例患者中有47例（58%）存在肌肉减少症。多因素分析确定肌肉减少症是CSS（风险比[HR]8.58，95%置信区间[CI]：1.63 - 158.1，P = 0.008）和OS（HR 6.05，95%CI 2.00 - 26.21，P < 0.001）的显著且独立的不良预后因素。在局部晚期疾病（pT3/4或pN+）患者中，存在肌肉减少症的患者CSS和OS明显差于无肌肉减少症的患者（5年CSS率55%对100%，P = 0.014；5年OS率40%对86%，P = 0.007）。相比之下，在器官局限性疾病（pTa - 2pN0/x）患者中，有和无肌肉减少症的患者之间未观察到预后差异。肌肉减少症是接受RNU治疗的UTUC患者的独立不良预后因素，尤其是对于局部晚期疾病患者。
