Gao Zhimin, Zhang Lei, Li Zhen, Qin Xu, Wang Zewei, Wang Junqi, Qi Nienie, Li Hailong
Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Graduate School of Xuzhou Medical University, Xuzhou, China.
Cancer Med. 2025 Apr;14(7):e70742. doi: 10.1002/cam4.70742.
For patients with bladder cancer (BC) undergoing radical cystectomy followed by adjuvant chemotherapy, the impact of visceral adipose tissue on prognosis and chemotherapy-related toxicities has not been well established.
From July 2013 to November 2020, 224 BC patients received adjuvant gemcitabine plus cisplatin at our institution. Computed tomography images of the patients were analyzed to calculate the visceral adipose tissue index (VATI). Patients were stratified into high- and low-VATI groups based on a predetermined cutoff value, and differences in prognosis and chemotherapy-related adverse events (AEs) between the two groups were compared.
After propensity score matching, a total of 166 patients were enrolled, with 83 in the low-VATI group and 83 in the high-VATI group. The low-VATI group exhibited notably extended progression-free survival (PFS) in comparison to the high-VATI group (p = 0.044). Conversely, no substantial variation was noted concerning overall survival (OS) among the patient cohorts. In the multivariable Cox regression analysis, patients aged over 70 years (HR = 1.66, 95% CI 1.09-2.57, p = 0.04) and nodal positivity (HR = 2.98, 95% CI 1.04-4.28, p = 0.01) emerged as significant risk factors for OS. In addition to the level of VATI (HR = 2.47, 95% CI 1.02-4.21, p = 0.04), nodal positivity (HR = 4.04, 95% CI 1.30-12.56, p = 0.02) remained a significant risk factor for PFS. Regarding chemotherapy-related AEs, the most common AEs of any grade and grade ≥ 3 were hematologic toxicities. Patients in the low-VATI group exhibited a higher likelihood of experiencing grade ≥ 3 neutropenia compared to those in the high-VATI group (p = 0.04).
This study demonstrated that, among patients treated with adjuvant chemotherapy for locally advanced BC, patients in the low-VATI group exhibited a significantly prolonged PFS compared to those in the high-VATI group. However, no significant difference was observed in terms of OS. Regarding chemotherapy-related AEs, patients in the high-VATI group exhibited a relatively lower incidence and severity of toxic reactions.
对于接受根治性膀胱切除术并辅助化疗的膀胱癌（BC）患者，内脏脂肪组织对预后及化疗相关毒性的影响尚未明确。
2013年7月至2020年11月，224例BC患者在我院接受吉西他滨联合顺铂辅助化疗。分析患者的计算机断层扫描图像以计算内脏脂肪组织指数（VATI）。根据预定的临界值将患者分为高VATI组和低VATI组，比较两组在预后及化疗相关不良事件（AE）方面的差异。
倾向评分匹配后，共纳入166例患者，低VATI组83例，高VATI组83例。与高VATI组相比，低VATI组的无进展生存期（PFS）显著延长（p = 0.044）。相反，患者队列的总生存期（OS）未观察到显著差异。在多变量Cox回归分析中，70岁以上患者（HR = 1.66，95%CI 1.09 - 2.57，p = 0.04）和淋巴结阳性（HR = 2.98，95%CI 1.04 - 4.28，p = 0.01）是OS的显著危险因素。除VATI水平外（HR = 2.47，95%CI 1.02 - 4.21，p = 0.04），淋巴结阳性（HR = 4.04，95%CI 1.30 - 12.56，p = 0.02）仍是PFS的显著危险因素。关于化疗相关AE，任何级别和≥3级最常见的AE是血液学毒性。与高VATI组患者相比，低VATI组患者发生≥3级中性粒细胞减少的可能性更高（p = 0.04）。
本研究表明，在接受局部晚期BC辅助化疗的患者中，低VATI组患者的PFS较之于高VATI组患者显著延长。然而，在OS方面未观察到显著差异。关于化疗相关AE，高VATI组患者的毒性反应发生率和严重程度相对较低。
