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Sarcopenia increased risk for mortality after radical cystectomy for bladder cancer
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Sarcopenia independently predicted shorter cancer-specific survival and OS among patients who underwent radical cystectomy for urothelial cancer of the bladder, according to results of a single-center study.
Sarah P. Psutka, MD, of the department of urology at Mayo Clinic in Rochester, Minn., and colleagues evaluated data from 205 patients with urothelial cancer of the bladder who underwent radical cystectomy between 2000 and 2007. Of these patients, 141 were sarcopenic, defined as skeletal muscle index ˂55 cm2/m2 for men and ˂39 cm2/m2 for women.
The median preoperative age of patients with sarcopenia was 72 years, which was significantly older than the rest of the population (67.5 years; P=.002). Patients with and without sarcopenia were otherwise similar with regard to sex, Charlson comorbidity index, American Society of Anesthesiologists score, ECOG performance status, receipt of neoadjuvant chemotherapy, TNM disease stage and tumor grade (P˃.05 for all).
Median follow-up was 6.7 years (interquartile range, 5.9-10.2). During this time, 135 patients died, 91 of whom died due to bladder cancer.
A significantly lower percentage of patients with sarcopenia achieved 5-year cancer-specific survival (49% vs. 72%; P=.003) and 5-year OS (39% vs. 70%; P=.003) than those without sarcopenia. The increased mortality rate associated with sarcopenia was apparent within 90 days following surgery (7.8% vs. 1.6%; P=.07).
Overall, sarcopenia was independently associated with all-cause mortality (HR=1.93; 95% CI, 1.23-3.00) and cancer-specific mortality (HR=2.14; 95% CI, 1.24-3.71).
“This association appears to be independent of commonly used comorbidity and performance status indices,” Psutka and colleagues wrote. “The assessment of lean muscle mass is objective and quickly obtained from standard preoperative imaging. As such, we propose the inclusion of this variable in preoperative risk stratification because it may be beneficial in both treatment planning and patient counseling. Furthermore, additional investigation is needed to determine the extent that preoperative interventions to modify skeletal muscle wasting may result in improved outcomes after radical cystectomy.”
Disclosure: One researcher reports a paid consultant role with Rochester Medical Company.
Perspective
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Sumanta K. Pal, MD
Ptsuka and colleagues have identified a compelling link between the presence of sarcopenia, or extreme muscle wasting, and cancer-specific survival in patients who have received cystectomy for bladder cancer. One must pay particular attention to the association between sarcopenia and older age. Both predicted risk of death on univariate analysis; however, only sarcopenia was predictive on multivariate analysis. Theoretically, this might suggest that sarcopenia more closely correlates with “physiologic age.” Immediate translation of these findings to the clinic is challenging — one would certainly not deny surgery to a sarcopenic patient on the basis of these findings. However, after further prospective validation, it might be worthwhile to examine if sarcopenic patients are better suited for bladder-sparing procedures (eg, maximal transurethral resection of bladder tumor followed by chemoradiation).
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