Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5266202, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Nutrients. 2021 Dec 14;13(12):4471. doi: 10.3390/nu13124471.
Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity.
We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes.
Ninety-one patients were included in the study. The median SMI change was -0.71 (-1.58, -0.06) cm/m. SMI decline was significantly higher in patients with post-RC complications (-18 vs. -203, < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively.
NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.
根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的标准治疗方法。新辅助化疗（NAC）可提高患者生存率。NAC 对营养状况的影响研究较少，而营养不良与手术不良结局的关系是众所周知的。本研究旨在探讨 NAC、营养状况受损与术后发病率之间的关系。
我们纳入了在以色列多个学术中心接受 RC 并接受 NAC 的 MIBC 患者。采用横断面影像学测量竖脊肌面积，并通过身高进行归一化（平滑肌肉指数，SMI）。计算 NAC 前后 SMI 的差异（代表营养状况的变化）。主要结局为 RC 后肠梗阻、感染和任何并发症的综合结局。采用逻辑回归模型确定结局的独立预测因素。
本研究共纳入 91 例患者。SMI 变化的中位数为-0.71（-1.58，-0.06）cm/m。RC 后发生并发症的患者 SMI 下降幅度明显更大（-18 与-203，<0.001）。SMI 变化是所有并发症、肠梗阻、感染和其他并发症的独立预测因素。SMI 变化预测所有并发症、肠梗阻、感染和其他并发症的准确性分别为 0.85、0.87、0.75 和 0.86。
NAC 相关的营养恶化与 RC 后并发症风险增加相关。我们的结果提示在 RC 前的 NAC 期间需要进行营养干预。
