Abstract
BackgroundAlthough the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change, from baseline, in nutritional status and volume of abdominal skeletal muscle mass and adipose tissue after radical cystetomy.MethodsA retrospective analysis of 89 patients with bladder cancer, who underwent curative radical cystectomy, was conducted to assess the time course of change, from baseline, in body composition and nutritional status at 1, 3, 6, 12, and 24 months, after surgery. Skeletal muscle mass and abdominal adipose tissue mass were quantified by unenhanced computed tomography images. Two different nutritional indices, the Prognostic Nutritional Index and the Controlling Nutritional Status score were calculated from laboratory blood tests. We evaluated the prognostic value of the rate of change in the body composition and nutritional status after radical cystectomy.ResultsThe cross-sectional area at the level of the third lumbar vertebra of the psoas major muscle and nutritional indices showed a transient deterioration at 1 and 3 months after radical cystectomy, with a return to baseline values from 6 to 24 months. A ≤ −10% loss in the area of the psoas muscle was associated with a shorter overall survival, compared to those with a > −10 change [hazard ratio (HR) 2.2, P = 0.02]. Multivariate analyzes identified sarcopenia status at baseline (HR 2.2, P = 0.03) and a ≤ −10% loss in the psoas muscle (HR 2.4, P = 0.02) were identified as independent prognostic factors for overall survival. A subanalysis of patients without sarcopenia identified a worse survival outcome for patients with a ≤ −10% loss in the psoas muscle (HR 2.6, P = 0.03) and ≤ − 5 change in the Prognostic Nutritional Index (HR 3.6, P = 0.01).ConclusionFurther research is required to establish appropriate rehabilitation protocols and nutritional interventions after radical cystectomy for maintaining skeletal muscle mass and nutrition status which could counteract physical deterioration and improve outcomes.
Highlights
The significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer
Studies have evaluated the relationship between postoperative complication and/or mortality and several preoperative factors, including body mass index (BMI), nutritional status, inflammation, host immunity, skeletal muscle mass and abdominal adipose tissue, in various malignant diseases, including bladder, upper urinary tract, kidney, prostate, colorectal, and hepatocellular carcinoma [4,5,6,7,8,9,10,11,12,13,14]
Baseline variables were compared between patients with and without sarcopenia (Table 2)
Summary
The significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Radical cystectomy (RC), with or without perioperative systemic chemotherapy, is the standard treatment for selected T1 high-grade and muscle invasive bladder cancer (≥T2; MIBC) [2, 3] Both postoperative complication and mortality are significant concerns in these patients. Studies have evaluated the relationship between postoperative complication and/or mortality and several preoperative factors, including body mass index (BMI), nutritional status, inflammation, host immunity, skeletal muscle mass (i.e., sarcopenia) and abdominal adipose tissue, in various malignant diseases, including bladder, upper urinary tract, kidney, prostate, colorectal, and hepatocellular carcinoma [4,5,6,7,8,9,10,11,12,13,14]. With regards to the effects of sarcopenia on postoperative outcomes, the clinical definition of age-related sarcopenia developed by The European Working Group on Sarcopenia in Older People (EWGSOP) in 2010 has been used, which bases the diagnosis of sarcopenia on documentation of low muscle mass, low muscle strength and low physical performance [15]
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