Division of Urology, McGill University Health Centre, Montreal, Canada.
Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada.
Urol Oncol. 2022 May;40(5):194.e15-194.e22. doi: 10.1016/j.urolonc.2021.11.002. Epub 2021 Nov 30.
We sought to investigate the incidence of sarcopenia and its impact on main oncological outcomes in patients with muscle invasive bladder cancer (MIBC) treated with trimodal therapy (TMT).
This was a retrospective analysis of 141 MIBC patients treated with TMT in the period 2002 to 2018. Sarcopenia was identified through pretreatment computed tomography scans and defined as a skeletal muscle index of <55 cm/m for men and <39 cm/m for women. Body mass index (BMI)-adjusted definition of sarcopenia was used to evaluate for sarcopenic obesity. Uni- and multivariable analyses were performed to assess the impact of sarcopenia on initial complete response and overall survival (OS) to TMT.
Median age at diagnosis was 73 years [range: 65-81] and median follow up was 32 months (Inter Quartile Range: 18-66). Median OS was 67 months (95% CI: 53-83). The incidence of sarcopenia and BMI-adjusted sarcopenia was 56.7% and 40.4%, respectively. On multivariable analysis, Eastern Cooperative Oncology Group performance status (HR = 2.37, 95% CI: 2.1-5.67, P = 0.001) and complete response to treatment (HR = 0.26, 95% CI: 0.14-0.049, P = 0.001] were independently associated with improved OS. Sarcopenia and BMI-adjusted sarcopenia were not independently associated with either complete response to TMT or OS. Similarly, in a subpopulation of 74 patients considered fit for radical cystectomy, we found that neither sarcopenia (P = 0.49) nor BMI-adjusted sarcopenia (P = 0.22) had an impact on OS.
Sarcopenia and BMI-adjusted sarcopenia are prevalent in patients with MIBC undergoing TMT. TMT is a suitable treatment modality for patients with MIBC irrespective of their sarcopenia status.
我们旨在研究在接受三联疗法（TMT）治疗的肌肉浸润性膀胱癌（MIBC）患者中，肌少症的发生率及其对主要肿瘤学结局的影响。
这是一项回顾性分析，纳入了 2002 年至 2018 年间接受 TMT 治疗的 141 例 MIBC 患者。通过预处理 CT 扫描识别肌少症，并定义男性骨骼肌指数<55 cm/m，女性<39 cm/m。使用 BMI 调整的肌少症定义来评估肌少性肥胖。进行单变量和多变量分析，以评估肌少症对 TMT 初始完全缓解和总生存（OS）的影响。
中位诊断年龄为 73 岁[范围：65-81]，中位随访时间为 32 个月（IQR：18-66）。中位 OS 为 67 个月（95%CI：53-83）。肌少症和 BMI 调整后肌少症的发生率分别为 56.7%和 40.4%。多变量分析显示，东部肿瘤协作组体力状况（HR=2.37，95%CI：2.1-5.67，P=0.001）和治疗完全缓解（HR=0.26，95%CI：0.14-0.049，P=0.001）与 OS 改善独立相关。肌少症和 BMI 调整后肌少症与 TMT 的完全缓解或 OS 均无独立相关性。同样，在 74 例被认为适合根治性膀胱切除术的患者亚组中，我们发现肌少症（P=0.49）和 BMI 调整后肌少症（P=0.22）均与 OS 无关。
在接受 TMT 的 MIBC 患者中，肌少症和 BMI 调整后肌少症很常见。TMT 是 MIBC 患者的一种合适的治疗方式，与肌少症状态无关。
