Abstract
Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Materials and Methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes. Results: Ninety-one patients were included in the study. The median SMI change was −0.71 (−1.58, −0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (−18 vs. −203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively. Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.
Highlights
Licensee MDPI, Basel, Switzerland.Bladder cancer is the most lethal neoplasm of the urinary tract with just over 81,000 patients diagnosed every year, 25% of which are muscle invasive (MIBC) at diagnosis [1].According to the European Association of Urology clinical guidelines, radical cystectomy (RC) with pelvic lymph node dissection is the standard of care for nonmetastatic muscle invasive bladder cancer (MIBC).Despite this radical approach, only 50% of the patients survive more than 5 years after diagnosis
This study aims to examine the association between Neoadjuvant chemotherapy (NAC) before Radical cystectomy (RC), poor nutritional status, and post-operative morbidity
Smooth muscle index (SMI) change was an independent predictor of all complications, ileus, infection, and other complications (Table 4)
Summary
According to the European Association of Urology clinical guidelines, radical cystectomy (RC) with pelvic lymph node dissection is the standard of care for nonmetastatic MIBC. Despite this radical approach, only 50% of the patients survive more than 5 years after diagnosis. Only 50% of the patients survive more than 5 years after diagnosis To improve these unsatisfactory results, neoadjuvant chemotherapy (NAC) has been. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Logistic regression models were fit to identify independent predictors of the outcomes
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