Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.
J Urol. 2019 Dec;202(6):1143-1149. doi: 10.1097/JU.0000000000000450. Epub 2019 Jul 17.
Skeletal muscle and fat mass indexes have emerged as easily obtained, objective and useful tools to assess susceptibility to unfavorable postoperative outcomes. We examined the association between skeletal muscle and fat mass indexes, and the discharge disposition after radical cystectomy.
In a retrospectively collected, single institution cohort we studied patients who underwent radical cystectomy with pelvic lymphadenectomy of primary, nonmetastatic muscle invasive bladder cancer between 2009 and 2015. Included patients had undergone adequate axial computerized tomography at the L3 level within 90 days prior to surgery. Skeletal muscle and fat mass indexes were measured on preoperative computerized tomography and relationships to the outcomes of interest were analyzed. Multivariable logistic regression analysis was performed to assess the effect of the skeletal muscle and fat mass indexes on the discharge disposition while controlling for age, comorbidities, complications and previous neoadjuvant chemotherapy.
A total of 136 patients met study inclusion criteria. The median skeletal muscle index among women and men in our study cohort was 36.4 and 47.6 cm/m, respectively. On multivariable logistic regression analysis a decreased skeletal muscle index (OR 0.94, 95% CI 0.90-0.98) and an increased fat mass index (OR 1.24, 95% CI 1.04-1.48) were associated with greater odds of discharge to a facility. Higher fat mass-to-skeletal muscle [corrected] index ratios were also associated with greater odds of discharge to a facility (OR 1.69, 95% CI 1.22-2.44). Study limitations include the retrospective design and unknown confounders.
Low skeletal muscle and high fat compositions are independent predictors of discharge to a facility after radical cystectomy of nonmetastatic muscle invasive bladder cancer.
骨骼肌和脂肪质量指数已成为评估术后不良结局易感性的简便、客观和有用的工具。我们研究了骨骼肌和脂肪质量指数与根治性膀胱切除术患者出院处置之间的关系。
在回顾性收集的单中心队列中，我们研究了 2009 年至 2015 年间接受根治性膀胱切除术和盆腔淋巴结清扫术的原发性、非转移性肌肉浸润性膀胱癌患者。纳入的患者在术前 90 天内接受了充分的 L3 水平轴向计算机断层扫描。在术前计算机断层扫描上测量骨骼肌和脂肪质量指数，并分析与感兴趣的结果的关系。多元逻辑回归分析用于评估骨骼肌和脂肪质量指数对出院处置的影响，同时控制年龄、合并症、并发症和新辅助化疗。
共有 136 名患者符合研究纳入标准。在我们的研究队列中，女性和男性的骨骼肌指数中位数分别为 36.4 和 47.6 cm/m。多元逻辑回归分析显示，骨骼肌指数降低（OR 0.94，95%CI 0.90-0.98）和脂肪质量指数增加（OR 1.24，95%CI 1.04-1.48）与出院到医疗机构的几率增加相关。较高的脂肪质量与骨骼肌[校正]指数比值也与出院到医疗机构的几率增加相关（OR 1.69，95%CI 1.22-2.44）。研究局限性包括回顾性设计和未知混杂因素。
低骨骼肌和高脂肪组成是非转移性肌肉浸润性膀胱癌根治性膀胱切除术后出院到医疗机构的独立预测因素。
