Abstract
BackgroundSarcopenia as the loss of skeletal muscle mass is related with poor postoperative survival. This work purposed to evaluate the prognostic prediction of the total psoas index (TPI), albumin–globulin score (AGS), and the combination of TPI and AGS (CTA) in bladder cancer (BCa) patients after radical cystectomy.MethodsBCa patients that received radical cystectomy between 2012 and 2020 were retrieved from our medical center. The calculation of TPI was based on the plain computed tomography images. The predictive effects of TPI, AGS, and CTA grade on survival of BCa patients were analyzed and compared with the albumin–globulin ratio (AGR) through the receiver operating characteristic (ROC) curves. A nomogram was further established based on the Cox regression results from CTA grade and clinicopathological characteristics, which are verified by the decision curve analysis (DCA).ResultsA total of 112 eligible patients diagnosed as BCa were included in this study for retrospective analysis. The patients with lower TPI or higher AGS grade (1/2) contained poorer overall survival (OS) and disease-free survival (DFS). Divided by CTA grade, there were 35 (31.25%) patients in grade 1 associated with the best postoperative prognosis, which was accompanied with increased TPI and decreased AGS. The CTA grade could better predict postoperative outcomes compared with TPI, AGR, and AGS for the highest area under the curve (AUC; 0.674 of OS and 0.681 of DFS). The 3- and 5-year OS and DFS nomograms were conducted based on CTA grade and clinical variables, with a higher predictive performance than the TNM stage.ConclusionThis study revealed that the novel index CTA functioned as an effective prognostic predictor for postoperative OS and DFS of BCa patients after radical cystectomy. Preoperative assessment of CTA would contribute to optimizing clinical therapies.
Highlights
Bladder cancer (BCa) is considered as one of the most malignant tumors without promising progress in the treatment for 30 years [1, 2]
This study aimed to evaluate the predictive effect of albumin–globulin score (AGS) and total psoas index (TPI) on the prognosis of postoperative BCa patients, simultaneously compared with albumin-to-globulin ratio (AGR)
The value of TPI is calculated based on the cross-sectional area from the two total psoas area (TPA) muscles which pass through the third lumbar (L3) cone
Summary
Bladder cancer (BCa) is considered as one of the most malignant tumors without promising progress in the treatment for 30 years [1, 2]. Surgery is the most effective treatment for BCa patients, and radical cystectomy (RC), the standard for invasive bladder cancer, has been worldly applied [4]. A simple and effective predictive factor or model for the prognosis of patients assists clinicians to establish the comprehensive individualized treatment of BCa, which will expand the survival time and quality. The albumin-to-globulin ratio (AGR) and albumin–globulin score (AGS), the indicators based on ALB and GLB, have been proved to function well in the prognosis evaluation of lung cancer and liver tumor [10, 13]. This work purposed to evaluate the prognostic prediction of the total psoas index (TPI), albumin–globulin score (AGS), and the combination of TPI and AGS (CTA) in bladder cancer (BCa) patients after radical cystectomy
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