Miyake Makito, Morizawa Yosuke, Hori Shunta, Marugami Nagaaki, Shimada Keiji, Gotoh Daisuke, Tatsumi Yoshihiro, Nakai Yasushi, Inoue Takeshi, Anai Satoshi, Torimoto Kazumasa, Aoki Katsuya, Tanaka Nobumichi, Fujimoto Kiyohide
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan.
Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan.
BMC Cancer. 2017 Mar 31;17(1):237. doi: 10.1186/s12885-017-3231-7.
Although the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change, from baseline, in nutritional status and volume of abdominal skeletal muscle mass and adipose tissue after radical cystetomy.
A retrospective analysis of 89 patients with bladder cancer, who underwent curative radical cystectomy, was conducted to assess the time course of change, from baseline, in body composition and nutritional status at 1, 3, 6, 12, and 24 months, after surgery. Skeletal muscle mass and abdominal adipose tissue mass were quantified by unenhanced computed tomography images. Two different nutritional indices, the Prognostic Nutritional Index and the Controlling Nutritional Status score were calculated from laboratory blood tests. We evaluated the prognostic value of the rate of change in the body composition and nutritional status after radical cystectomy.
The cross-sectional area at the level of the third lumbar vertebra of the psoas major muscle and nutritional indices showed a transient deterioration at 1 and 3 months after radical cystectomy, with a return to baseline values from 6 to 24 months. A ≤ -10% loss in the area of the psoas muscle was associated with a shorter overall survival, compared to those with a > -10 change [hazard ratio (HR) 2.2, P = 0.02]. Multivariate analyzes identified sarcopenia status at baseline (HR 2.2, P = 0.03) and a ≤ -10% loss in the psoas muscle (HR 2.4, P = 0.02) were identified as independent prognostic factors for overall survival. A subanalysis of patients without sarcopenia identified a worse survival outcome for patients with a ≤ -10% loss in the psoas muscle (HR 2.6, P = 0.03) and ≤ - 5 change in the Prognostic Nutritional Index (HR 3.6, P = 0.01).
Further research is required to establish appropriate rehabilitation protocols and nutritional interventions after radical cystectomy for maintaining skeletal muscle mass and nutrition status which could counteract physical deterioration and improve outcomes.
尽管术前营养状况的意义已得到研究，但对于接受膀胱癌根治性膀胱切除术的患者，术后营养状况变化与预后之间的关系尚无相关报道。在此，我们报告根治性膀胱切除术后营养状况以及腹部骨骼肌质量和脂肪组织量相对于基线的变化所产生的临床影响。
对89例行根治性膀胱切除术的膀胱癌患者进行回顾性分析，以评估术后1、3、6、12和24个月时身体成分和营养状况相对于基线的变化时间进程。通过非增强计算机断层扫描图像对骨骼肌质量和腹部脂肪组织质量进行量化。根据实验室血液检查计算两种不同的营养指标，即预后营养指数和控制营养状况评分。我们评估了根治性膀胱切除术后身体成分和营养状况变化率的预后价值。
腰大肌在第三腰椎水平的横截面积和营养指标在根治性膀胱切除术后1个月和3个月出现短暂恶化，6至24个月恢复至基线值。与腰大肌面积变化>-10%的患者相比，腰大肌面积减少≤-10%与总生存期缩短相关[风险比（HR）2.2，P = 0.02]。多因素分析确定基线时的肌肉减少症状态（HR 2.2，P = 0.03）和腰大肌减少≤-10%（HR 2.4，P = 0.02）是总生存期的独立预后因素。对无肌肉减少症患者的亚组分析发现，腰大肌减少≤-10%（HR 2.6，P = 0.03）和预后营养指数变化≤-5（HR 3.6，P = 0.01）的患者生存结局较差。
需要进一步研究以制定合适的康复方案和营养干预措施，用于根治性膀胱切除术后维持骨骼肌质量和营养状况，从而对抗身体机能衰退并改善预后。
