Hirasawa Yosuke, Nakashima Jun, Yunaiyama Daisuke, Sugihara Toru, Gondo Tatsuo, Nakagami Yoshihiro, Horiguchi Yutaka, Ohno Yoshio, Namiki Kazunori, Ohori Makoto, Tokuuye Koichi, Tachibana Masaaki
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Department of Urology, Sanno Hospital, Tokyo, Japan.
Ann Surg Oncol. 2016 Dec;23(Suppl 5):1048-1054. doi: 10.1245/s10434-016-5606-4. Epub 2016 Oct 3.
To investigate the prognostic significance of sarcopenia on long-term outcomes in patients with bladder cancer after radical cystectomy (RC).
We retrospectively reviewed 136 patients undergoing RC for urothelial carcinoma at our institution. Prognostic impact of the preoperative clinical, laboratory, and radiologic parameters were evaluated by Cox proportional hazard model analyses, and a nomogram was developed to predict cancer-specific survival (CSS) after RC.
The mean follow-up was 46.7 months. Patients with sarcopenia had a significantly shorter CSS than those without sarcopenia. On univariate Cox analysis, clinical T stage, histology of transurethral resection of bladder tumor (TURBT) specimen, pretreatment hemoglobin, pretreatment neutrophil-to-lymphocyte ratio (NLR), pretreatment serum C-reactive protein level, pretreatment serum albumin level, presence of hydronephrosis, and presence of sarcopenia were associated with significantly worse CSS. On multivariate Cox stepwise analysis, sarcopenia (hazard rate [HR] = 2.3, p = 0.015), clinical T stage (cT4: HR = 5.3; p = 0.0096), presence of hydronephrosis (HR = 2.0; p = 0.033), histology of TURBT specimen (HR = 2.2, p = 0.044), and NLR (HR = 1.3; p = 0.0048) were significant independent predictors of an unfavorable prognosis Based on the results of the multivariate analysis, we developed a nomogram to predict 1-, 3-, and 5-year CSS after RC.
Sarcopenia, clinical T stage, presence of hydronephrosis, histology of TURBT specimen, and NLR are novel preoperative prognostic factors even after adjustment for other known preoperative predictors in patients undergoing RC for bladder cancer.
探讨肌肉减少症对根治性膀胱切除术（RC）后膀胱癌患者长期预后的意义。
我们回顾性分析了我院136例行RC治疗尿路上皮癌的患者。通过Cox比例风险模型分析评估术前临床、实验室和影像学参数的预后影响，并绘制列线图以预测RC后的癌症特异性生存（CSS）。
平均随访时间为46.7个月。肌肉减少症患者的CSS明显短于无肌肉减少症的患者。单因素Cox分析显示，临床T分期、膀胱肿瘤经尿道切除术（TURBT）标本的组织学类型、术前血红蛋白、术前中性粒细胞与淋巴细胞比值（NLR）、术前血清C反应蛋白水平、术前血清白蛋白水平、肾积水的存在以及肌肉减少症的存在与CSS显著相关。多因素Cox逐步分析显示，肌肉减少症（风险比[HR]=2.3，p=0.015）、临床T分期（cT4：HR=5.3；p=0.0096）、肾积水的存在（HR=2.0；p=0.033）、TURBT标本的组织学类型（HR=2.2，p=0.044）和NLR（HR=1.3；p=0.0048）是不良预后的重要独立预测因素。基于多因素分析结果，我们绘制了列线图以预测RC后1年、3年和5年的CSS。
即使在对接受RC治疗的膀胱癌患者的其他已知术前预测因素进行调整后，肌肉减少症、临床T分期、肾积水的存在、TURBT标本的组织学类型和NLR仍是新的术前预后因素。
