Sarcopenia as a Predictor of Complications and Survival Following Radical Cystectomy
2014; Lippincott Williams & Wilkins; Volume: 191; Issue: 6 Linguagem: Inglês
10.1016/j.juro.2013.12.047
ISSN1527-3792
AutoresAngela Smith, Allison M. Deal, Hyeon Yu, Brian A. Boyd, Jonathan Matthews, Eric Wallen, Raj S. Pruthi, Michael Woods, Hyman B. Muss, Matthew E. Nielsen,
Tópico(s)Nutrition and Health in Aging
ResumoNo AccessJournal of UrologyAdult Urology1 Jun 2014Sarcopenia as a Predictor of Complications and Survival Following Radical Cystectomy Angela B. Smith, Allison M. Deal, Hyeon Yu, Brian Boyd, Jonathan Matthews, Eric M. Wallen, Raj S. Pruthi, Michael E. Woods, Hyman Muss, and Matthew E. Nielsen Angela B. SmithAngela B. Smith Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Allison M. DealAllison M. Deal Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Hyeon YuHyeon Yu Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Brian BoydBrian Boyd Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Jonathan MatthewsJonathan Matthews Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Eric M. WallenEric M. Wallen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with MDx Health. More articles by this author , Raj S. PruthiRaj S. Pruthi Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Michael E. WoodsMichael E. Woods Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with LabCorp. More articles by this author , Hyman MussHyman Muss Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Geriatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , and Matthew E. NielsenMatthew E. Nielsen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.12.047AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients undergoing radical cystectomy face substantial but highly variable risks of major complications. Risk stratification may be enhanced by objective measures such as sarcopenia. Sarcopenia (loss of skeletal muscle mass) has emerged as a novel biomarker associated with adverse outcomes in many clinical contexts relevant to cystectomy. Based on these data we hypothesized that sarcopenia would be associated with increased 30-day major complications and mortality after radical cystectomy for bladder cancer. Materials and Methods: We performed a retrospective study of patients treated with radical cystectomy at our institution from 2008 to 2011. Sarcopenia was assessed by measuring cross-sectional area of the psoas muscle (total psoas area) on preoperative computerized tomography. Cutoff points were developed and evaluated using ROC curves to determine predictive ability in men and women for outcomes of major complications and survival. Results: Of 224 patients with bladder cancer 200 underwent preoperative computerized tomography within 1 month of surgery. Total psoas area was calculated with a mean score of 712 and 571 cm2/m2 in men and women, respectively. A clear association was noted between major complications and lower total psoas area in women using a cutoff of 523 cm2/m2 to define sarcopenia (AUC 0.70). Sarcopenia was not significantly associated with complications in men. There was a nonsignificant trend of sarcopenia with worse 2-year survival. Conclusions: Sarcopenia in women was a predictor of major complications after radical cystectomy. Further research confirming sarcopenia as a useful predictor of complications would support the development of targeted interventions to mitigate the untoward effects of sarcopenia before cancer surgery. References 1 : Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol2009; 56: 443. Google Scholar 2 : Complications of radical cystectomy for carcinoma of the bladder. J Urol1980; 123: 640. Link, Google Scholar 3 : Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol2002; 167: 2012. Link, Google Scholar 4 : Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?. BJU Int2009; 104: 986. Google Scholar 5 : Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol2005; 174: 1231. Link, Google Scholar 6 : Invited review: aging and sarcopenia. J Appl Physiol2003; 95: 1717. Google Scholar 7 : Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res2009; 15: 2920. Google Scholar 8 : Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. J Clin Oncol2010; 28: 1054. Google Scholar 9 : Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol2010; 28: 340. Google Scholar 10 : Carla Task Force on Sarcopenia: propositions for clinical trials. J Nutr Health Aging2009; 13: 700. Google Scholar 11 : Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol2008; 9: 629. Google Scholar 12 : Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer2012; 107: 931. Google Scholar 13 : Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg2012; 16: 1478. Google Scholar 14 : Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford)2011; 13: 439. Google Scholar 15 : Sarcopenia and mortality after liver transplantation. J Am Coll Surg2010; 211: 271. Google Scholar 16 : Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol2009; 55: 164. Google Scholar 17 : Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol2004; 97: 2333. Google Scholar 18 : A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab2008; 33: 997. Google Scholar 19 : ROC Analysis for the Evaluation of Continuous Biomarkers: Existing Tools and New Features in SAS® 9.2. Paper SP09-2009. San Diego: Beckman Coulter2009. Google Scholar 20 : Index for rating diagnostic tests. Cancer1950; 3: 32. Google Scholar 21 : Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg2010; 210: 901. Google Scholar 22 : Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg2013; 217: 665. Google Scholar 23 : Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing2010; 39: 412. Google Scholar 24 : Effect of preoperative exercise on cardiorespiratory function and recovery after surgery: a systematic review. World J Surg2013; 37: 711. Google Scholar 25 : Nonsteroidal selective androgen receptor modulators (SARMs): dissociating the anabolic and androgenic activities of the androgen receptor for therapeutic benefit. J Med Chem2009; 52: 3597. Google Scholar 26 : The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: results of a double-blind, placebo-controlled phase II trial. J Cachexia Sarcopenia Muscle2011; 2: 153. Google Scholar 27 : Effects of enobosarm on muscle wasting and physical function in patients with cancer: a double-blind, randomised controlled phase 2 trial. Lancet Oncol2013; 14: 335. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAlbersheim J, Sathianathen N, Zabell J, Renier J, Bailey T, Hanna P, Konety B and Weight C (2019) Skeletal Muscle and Fat Mass Indexes Predict Discharge Disposition after Radical CystectomyJournal of Urology, VOL. 202, NO. 6, (1143-1149), Online publication date: 1-Dec-2019.Pak S, Park S, Shin T, You D, Jeong I, Hong J, Kim C and Ahn H (2019) Association of Muscle Mass with Survival after Radical Prostatectomy in Patients with Prostate CancerJournal of Urology, VOL. 202, NO. 3, (525-532), Online publication date: 1-Sep-2019.Ritch C, Cookson M, Clark P, Chang S, Fakhoury K, Ralls V, Thu M, Penson D, Smith J and Silver H (2019) Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled TrialJournal of Urology, VOL. 201, NO. 3, (470-477), Online publication date: 1-Mar-2019.Lee J, Lee H, Ha J, Han K, Rha K, Hong S, Chung B and Koo K (2018) Subcutaneous Fat Distribution is a Prognostic Biomarker for Men with Castration Resistant Prostate CancerJournal of Urology, VOL. 200, NO. 1, (114-120), Online publication date: 1-Jul-2018.Michalak J, Lin F and Twiss C (2016) Review Article: Preoperative Evaluation and Optimization of the Geriatric Urological PatientUrology Practice, VOL. 4, NO. 6, (499-507), Online publication date: 1-Nov-2017.Griebling T (2017) Re: Frailty and Post-Operative Outcomes in Older Surgical Patients: A Systematic ReviewJournal of Urology, VOL. 198, NO. 2, (229-230), Online publication date: 1-Aug-2017.Sharma P, Henriksen C, Zargar-Shoshtari K, Xin R, Poch M, Pow-Sang J, Sexton W, Spiess P and Gilbert S (2015) Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical CystectomyJournal of Urology, VOL. 195, NO. 1, (47-52), Online publication date: 1-Jan-2016.Griebling T (2015) Re: Can Routine Preoperative Data Predict Adverse Outcomes in the Elderly? Development and Validation of a Simple Risk Model Incorporating a Chart-Derived Frailty ScoreJournal of Urology, VOL. 194, NO. 4, (1029-1029), Online publication date: 1-Oct-2015.Downs T (2015) Reducing Readmissions and Mortality after Radical CystectomyJournal of Urology, VOL. 193, NO. 5, (1461-1462), Online publication date: 1-May-2015.Psutka S, Boorjian S, Moynagh M, Schmit G, Frank I, Carrasco A, Stewart S, Tarrell R, Thapa P and Tollefson M (2014) Mortality after Radical Cystectomy: Impact of Obesity Versus Adiposity after Adjusting for Skeletal Muscle WastingJournal of Urology, VOL. 193, NO. 5, (1507-1513), Online publication date: 1-May-2015. Volume 191Issue 6June 2014Page: 1714-1720Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordspostoperative complicationssarcopeniaprognosiscystectomyurinary bladder neoplasmsMetricsAuthor Information Angela B. Smith Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Allison M. Deal Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Hyeon Yu Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Brian Boyd Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Jonathan Matthews Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Eric M. Wallen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with MDx Health. More articles by this author Raj S. Pruthi Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Michael E. Woods Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Financial interest and/or other relationship with LabCorp. More articles by this author Hyman Muss Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Geriatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Matthew E. Nielsen Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Expand All Advertisement PDF downloadLoading ...
Referência(s)