Department of Urology, Emory University School of Medicine, Atlanta, GA.
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.
Urol Oncol. 2023 Jan;41(1):50.e19-50.e26. doi: 10.1016/j.urolonc.2022.09.020. Epub 2022 Oct 21.
A universally accepted model for preoperative surgical risk stratification in localized RCC patients undergoing nephrectomy is currently lacking. Both the evaluation of body composition and nutritional status has demonstrated prognostic value for patients with cancer. This study aims to investigate the potential associations between sarcopenia and hypoalbuminemia and survival outcomes in patients with localized kidney cancer treated with partial or radical nephrectomy.
We retrospectively analyzed 473 patients with localized RCC managed with radical and partial nephrectomy. Skeletal muscle index (SMI) was measured from preoperative CT and MRI. Sarcopenic criteria were created using BMI- and sex-stratified thresholds. Relationships between sarcopenia and hypoalbuminemia (Albumin <3.5 g/dL) with overall (OS), recurrence-free (RFS), and cancer-specific survival (CSS) were determined using multivariable and Kaplan-Meier analysis.
Of the 473 patients, 42.5% were sarcopenic and 24.5% had hypoalbuminemia. Sarcopenia was significantly associated with shorter OS (HR=1.51, 95% CI 1.07-2.13), however, was nonsignificant in the RFS (HR = 1.33, 95% CI 0.88-2.03) and CSS (HR=1.66, 95% CI 0.96-2.87) models. Hypoalbuminemia predicted shorter OS (HR=1.76, 95% CI 1.22-2.55), RFS (HR=1.86, 95% CI 1.19-2.89), and CSS (HR=1.82, 95% CI 1.03-3.22). Patients were then stratified into low, medium, and high-risk groups based on the severity of sarcopenia and hypoalbuminemia. Risk groups demonstrated an increasing association with shorter OS (all p<0.05). Reduced RFS was observed in the medium risk-hypoalbuminemia (HR=2.18, 95% CI 1.16-4.09) and high-risk groups (HR=2.42, 95% CI 1.34-4.39). Shorter CSS was observed in the medium risk-hypoalbuminemia (HR=2.31, 95% CI 1.00-5.30) and high-risk groups (HR=2.98, 95% CI 1.34-6.61).
Localized RCC patients with combined preoperative sarcopenia and hypoalbuminemia displayed a two to a three-fold reduction in OS, RFS, and CSS after nephrectomy. These data have implications for guiding prognostication and treatment election in localized RCC patients undergoing extirpative surgery.
目前，对于接受肾切除术的局限性 RCC 患者，缺乏普遍接受的术前手术风险分层模型。身体成分和营养状况的评估均已证明对癌症患者具有预后价值。本研究旨在探讨局限性肾癌患者接受部分或根治性肾切除术治疗后，肌肉减少症和低白蛋白血症与生存结局之间的潜在关联。
我们回顾性分析了 473 例接受根治性和部分肾切除术治疗的局限性 RCC 患者。从术前 CT 和 MRI 测量骨骼肌指数 (SMI)。使用 BMI 和性别分层阈值创建肌少症标准。使用多变量和 Kaplan-Meier 分析确定肌肉减少症和低白蛋白血症（Albumin <3.5 g/dL）与总生存期（OS）、无复发生存期（RFS）和癌症特异性生存期（CSS）之间的关系。
在 473 例患者中，42.5%为肌肉减少症患者，24.5%为低白蛋白血症患者。肌肉减少症与较短的 OS（HR=1.51，95%CI 1.07-2.13）显著相关，但在 RFS（HR=1.33，95%CI 0.88-2.03）和 CSS（HR=1.66，95%CI 0.96-2.87）模型中无统计学意义。低白蛋白血症预测较短的 OS（HR=1.76，95%CI 1.22-2.55）、RFS（HR=1.86，95%CI 1.19-2.89）和 CSS（HR=1.82，95%CI 1.03-3.22）。然后根据肌肉减少症和低白蛋白血症的严重程度将患者分为低、中、高危组。风险组与较短的 OS 呈正相关（均 p<0.05）。中危低白蛋白血症（HR=2.18，95%CI 1.16-4.09）和高危组（HR=2.42，95%CI 1.34-4.39）观察到 RFS 降低。中危低白蛋白血症（HR=2.31，95%CI 1.00-5.30）和高危组（HR=2.98，95%CI 1.34-6.61）观察到 CSS 缩短。
局限性 RCC 患者术前同时存在肌肉减少症和低白蛋白血症，肾切除术后 OS、RFS 和 CSS 降低 2 至 3 倍。这些数据对指导局限性 RCC 患者接受切除术的预后和治疗选择具有重要意义。
