Abstract
ObjectivesTo investigate the prognostic significance of sarcopenic cachexia compared to sarcopenia without cachexia in the outcomes of upper urinary tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU).Materials and methodsBetween 2011 and 2016, 163 patients with UTUC who received RNU at a tertiary medical center were included. Pre-operatively clinical data, history, and abdominal computer tomography scans were analyzed retrospectively. The diagnosis of sarcopenia was based on abdominal computed tomography data on the patient’s skeletal muscles. Outcomes of relapse-free, cancer-specific, and overall survival were analyzed by multivariate Cox regression.ResultsAfter adjusting for age, sex, pre-operatively estimated glomerular filtration rate, body mass index, underlying diseases, tumor grade, and tumor stage, cachexia was a significant poor prognostic factor for relapse-free survival (hazard ratio [HR]: 18.5, 95% confidence interval [CI]: 2.87–118, p = 0.002) and cancer-specific survival (HR: 26.6, 95% CI: 4.04–175, p = 0.001). In contrast, sarcopenia without cachexia was not a significant predictor of cancer outcomes.ConclusionsTo date, this is the first study to investigate the effect of cachexia among sarcopenic patients with UTUC treated with RNU. We identified the prognostic significance of cachexia on outcomes. Indeed, when UTUC is treated with RNU, we should evaluate not only sarcopenia status but also cachexia. The low survival rate among patients with UTUC complicated with cachexia deserves attention.
Highlights
Radical nephroureterectomy (RNU) is the standard of care for patients with nonmetastatic upper urinary tract urothelial carcinoma (UTUC), the prognosis after radical nephroureterectomy (RNU) is relatively poor
After adjusting for age, sex, pre-operatively estimated glomerular filtration rate, body mass index, underlying diseases, tumor grade, and tumor stage, cachexia was a significant poor prognostic factor for relapse-free survival and cancer-specific survival (HR: 26.6, 95% confidence interval (CI): 4.04–175, p = 0.001)
Sarcopenia without cachexia was not a significant predictor of cancer outcomes. This is the first study to investigate the effect of cachexia among sarcopenic patients with UTUC treated with RNU
Summary
Radical nephroureterectomy (RNU) is the standard of care for patients with nonmetastatic upper urinary tract urothelial carcinoma (UTUC), the prognosis after RNU is relatively poor. Recent studies revealed a novel concept that sarcopenia was associated with unfavorable prognosis in patients with various cancers of the respiratory, gastrointestinal, and urinary tracts [7,8,9,10,11,12,13]. These studies focused on the comparison of patients with or without sarcopenia. No study has reported the effect of cachexia on oncological outcomes in cancer patients with sarcopenia.
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