Radical Cystectomy For Bladder Cancer Research Articles

Sarcopenia as an independent predictor for venous thromboembolism events in bladder cancer patients undergoing radical cystectomy.

Sarcopenia has been proved to be related to the prognosis of patients with bladder cancer (BC) after radical cystectomy (RC). The relationship between sarcopenia and the occurrence of venous thromboembolism (VTE) after RC is unclear. We collected data of 252 BC patients treated with RC at our institution. Data was obtained from the electronic medical record database. Sarcopenia was defined by the third lumbar vertebra skeletal muscle index (SMI) which was measured using preoperative computed tomography. The primary outcome was the incidence of VTE within 30days after the surgery in sarcopenia and non-sarcopenia groups. Outcomes between the two cohorts were compared using univariate analysis. Multivariate logistic regression was used to control for differences between cohorts. Two hundred fifty-two patients were enrolled, of which 85 (33.7%) patients were in sarcopenia group, while 167 (66.3%) patients were not in sarcopenia group. The incidence of total VTE in sarcopenia group was higher than that in the extended group (10.6% vs. 1.8%, p = 0.005). Sarcopenia did not cause an increase in other postoperation 30days complications (all p > 0.05). Multivariate analysis confirmed sarcopenia was independently associated with increased odds of VTE (OR = 4.18, 95% CI [1.01-17.27]; p = 0.048). Subgroup analysis showed that patients with VTE tended to be older (76.5 vs 66.0, p = 0.025) and have higher proportion of diabetes (58.3% vs 14.2%, p < 0.001) as well as lower level of serum albumin (35.0g/L vs 40.4g/L, p = 0.023) compared with those without VTE. Sarcopenia was an independent predictor for VTE with patients undergoing RC for BC.

Supportive care needs and utilization of bladder cancer patients undergoing radical cystectomy: A longitudinal study.

Investigating supportive care (SC) needs and utilization/willingness to use SC services from diagnosis to one year after radical cystectomy in bladder cancer (BC) patients. MATERIALS& METHODS: A longitudinal cohort study was conducted in 90 BC patients at Ghent/Leuven University Hospitals between April 2017 and December 2020. The Supportive Care Needs Survey-short form (SCNS-SF34) was used before radical cystectomy, one, three, six and 12 months after radical cystectomy. Additional questions assessed utilization/willingness to use SC services. Linear mixed models were performed. The majority of BC patients report at least one moderate or high SC need at diagnosis (82%), month 1 (84%), month 3 (86%), month 6 (64%), and month 12 (60%). Significant decreases over time were seen for all domains (p<0.001), except for sexuality (p=0.275). From baseline to month 1, physical needs first significantly increased (p=0.001) after which they decreased. Psychological (e.g. fears about the future) and informational (e.g. information on how to get better) needs were most common at baseline whereas physical (e.g. lack of energy) and informational needs were more common in the early postoperative phases. The majority of patients (ranging from 81% (month 1) to 91% (month 12)) did not make use of SC services and the majority of the patients (ranging from 81% (month 1) to 88% (month 12)) did not wish to talk about their problems to someone. Those willing to talk to someone preferred their physician. A clear gap exists between the large proportion of SC needs experienced by BC patients undergoing radical cystectomy and the low use of SC services.

Prognostic Value of the Systemic Inflammatory Response Index in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Population-Based Study.

PurposeThe aim of this study was to evaluate the prognostic significance of the systemic inflammatory response index (SIRI) in patients with bladder cancer (BCa) treated with radical cystectomy (RC) and develop a survival predictive model through establishing a nomogram.Materials and MethodsA total of 203 BCa patients who underwent RC were included in this study. The relationship between the SIRI and overall survival (OS), disease-free survival (DFS), and clinicopathological features were evaluated. Cox regression analysis was performed to investigate the effect of the factors on the OS and DFS. The results were applied in the establishment of a nomogram. Receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves were performed to assess the predictive performance and accuracy of the nomogram, respectively.ResultsAccording to the classification of the SIRI, 81 patients (39.9%) were assigned to SIRI grade 1, 94 patients (46.3%) to SIRI grade 2, and the remaining 28 patients (13.8%) to SIRI grade 3. Multivariate Cox regression revealed that a higher SIRI grade was significantly associated with a poor prognosis and served as an independent prognostic factor for the OS [Grade 2 vs Grade 1, odds ratio = 2.54, 95% confidence interval (CI),1.39–4.64, P = 0.002; Grade 3 vs Grade 1, odds ratio = 4.79, 95%CI: 2.41–9.50, P < 0.001] and DFS [Grade 2 vs Grade 1, odds ratio = 2.19, 95% CI, 1.12–4.31, P = 0.023; Grade 3 vs Grade 2, odds ratio = 3.36, 95%CI, 1.53–7.35, P = 0.002]. The ROC and DCA analysis indicated that the nomogram based on the SIRI contained a better predictive performance compared with the TNM stage (AUC = 0.750 and 0.791; all P < 0.05). The ROC analysis showed that nomograms can better predict the 3- and 5-year OS and DFS. The calibration curves exhibited a significant agreement between the nomogram and the actual observation.ConclusionSIRI as a novel independent prognostic index and potential prognostic biomarker can effectively improve the traditional clinicopathological analysis and optimize individualized clinical treatments for BCa patients after RC.

This Month in Adult Urology

This Month in Adult Urology

Vaginal Complications after Radical Cystectomy for Bladder Cancer: A Systematic Review

To summarize the published literature regarding pelvic organ prolapse, dehiscence or evisceration, vaginal fistula, and dyspareunia after radical cystectomy and to describe the management approaches used to treat these conditions. Ovid MEDLINE, Ovid EMBASE, and Web of Science were systematically searched from January 1, 2001 to January 25, 2021 using a combination of search terms for bladder cancer and radical cystectomy with terms for four categories of vaginal complications (prolapse, fistula, evisceration/dehiscence, and dyspareunia). A total of 229 publications were identified, the final review included 28 publications. Neobladder vaginal fistula was evaluated in 17 publications, with an incidence rate of 3 - 6% at higher volume centers, often along the anterior vaginal wall at the location of the neobladder-urethral anastomosis. Sexual function was evaluated in 10 studies, 7 of which utilized validated instruments. Maintaining the anterior vaginal wall and the distal urethra appeared to be associated with improved sexual function. Pelvic organ prolapse was assessed in 5 studies, only 1 used a validated questionnaire and none included a validated objective measure of pelvic organ support. There is a need for more prospective studies, using standardized instruments and subjective outcome measures to better define the incidence of vaginal complications after radical cystectomy for bladder cancer, and to understand their impact on quality of life measures.

IJU this issue

In this issue, one Review Article, seven Original Articles, two Urological Notes and nine Editorial Comments (total 19 manuscripts) are published. Shigemura and Fujisawa (Hyogo, Japan) reviewed the prevention and management of infectious complications in prostate biopsy. Miyamoto et al. (Nara, Japan) reported on the clinical outcomes after intravesical bacillus Calmette–Guérin for the highest-risk non-muscle-invasive bladder cancer newly defined in the Japanese Urological Association Guidelines 2019. Tabei et al. (Kanagawa, Japan) investigated the efficacy of re-do urethroplasty for post-traumatic urethral stricture in terms of anatomical and functional outcomes to show a high success rate and beneficial effects on both anatomical and functional outcomes. Taoka et al. (Kagawa, Japan) showed the therapeutic benefits of a surgical checklist in improving the quality of resection during transurethral resection and reducing the recurrence rate in patients with non-muscle-invasive bladder cancer. Hata et al. (Fukushima, Japan) identified the preoperative low bladder contractile index as the predictor of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy. Shin and Mimata (Oita, Japan) described the “early pull-out” technique for intracorporeal ileal conduit urinary diversion after robot-assisted radical cystectomy. Aizawa et al. (Kyoto, Japan) reported that prostate-targeted treatment plus metastasis-directed therapy through external beam radiation therapy can result in favorable long-term disease-free and survival outcomes with acceptable morbidities among synchronous oligometastatic prostate cancer patients. Iguchi et al. (Osaka, Japan) reported that enzalutamide plus androgen deprivation therapy has clinical benefit with a tolerable safety profile in Japanese men with metastatic hormone-sensitive prostate cancer, consistent with the overall population. Yamashita et al. (Wakayama, Japan) evaluated the prognostic impact of sarcopenia and myosteatosis on survival after radical cystectomy for bladder cancer. Unfortunately, the limited space does not allow me to introduce all the papers. However, all the articles in this issue are very informative and interesting, so please enjoy it by all means. None declared.

Metastasis-directed radiation therapy after radical cystectomy for bladder cancer

PurposeMetastasis-directed radiation therapy (MDRT) may improve oncologic and quality of life outcomes in patients with metastatic cancer, but data on its use in metastatic bladder cancer is severely limited. We sought to review our institutional experience with MDRT in patients with metastatic bladder cancer following radical cystectomy. Materials and MethodsWe reviewed records of patients who underwent radical cystectomy and subsequent MDRT at our institution between 2009 and 2020. Baseline demographic and clinical/pathologic factors were collected, as were details of treatment including systemic therapy and MDRT. Cases were categorized by treatment intent as consolidative (intended to prolong survival) and palliative (intended only to relieve symptoms). Response to treatment, survival, and toxicity outcomes were reviewed. ResultsA total of 52 patients underwent MDRT following radical cystectomy. MDRT was categorized as consolidative in 40% of cases and palliative in 60%. Toxicity (CTCAE Grade ≥ 2) was reported in 15% of patients, none of which exceeded Grade 3. Most patients undergoing consolidative MDRT were treated with SBRT techniques (76%) and a majority (67%) received concurrent treatment with an immuno-oncology agent. Among patients treated with consolidative intent, 2-year progression-free and overall survival were 19% and 60%, respectively. ConclusionMDRT is safe and well-tolerated by a majority of patients. A majority of patients treated with consolidative intent survived ≥ 2 years from treatment.

Feasibility of wearable activity trackers in cystectomy patients to monitor for postoperative complications.

Background:To determine the feasibility of using wearables in patients undergoing radical cystectomy to monitor postoperative heart rate and activity and attempt to correlate these factors to complications and readmissions.Materials and methods:We conducted a prospective study of 20 patients undergoing radical cystectomy for bladder cancer between June 2017 and March 2018. Each patient was provided with a Garmin Vívofit heart rate (HR) activity tracker and instructed to wear it on their wrist for 30 days postoperatively. Heart rate, steps, and sleep data were collected during this time. Patients were called at 10-day intervals and surveyed for complications and device compliance. Univariable mixed effects logistic regression models were used to compare daily activity tracker measures with occurrence of an adverse event. Odds ratios, 95% confidence intervals, and p-values were reported.Results:Median age was 65 (interquartile range 61–74) years. Patients had usable data for a median of 59.3% (interquartile range 25–71.7%) of the time. Five patients experienced a postoperative event (1 readmission for sepsis from urinary tract source, 1 inpatient rapid response called for tachycardic event, 3 unscheduled visits related to dehydration), where event data was recorded over a total of 17 days. Higher step count was associated with reduced odds of an adverse event (odds ratio 0.31, 95% confidence interval 0.10–0.98 per 1000 steps, p = 0.047).Conclusions:Postoperative activity and heart rate monitoring in cystectomy patients is feasible though current wearables are not well suited for this task.

Survival after radical cystectomy during holiday periods

Objective For patients undergoing radical cystectomy for bladder cancer, a procedure requiring complex urinary tract reconstruction prone to major postoperative complications, the timing and quality of the surgery have been associated with outcomes. Patients and methods This study investigated if radical cystectomy for bladder cancer performed during holiday periods had worse disease-specific (DSS) and overall survival (OS), higher 90-day mortality and risk of readmissions. All patients operated on with radical cystectomy for primary bladder cancer during 1997–2014 with holiday periods as exposure (with one narrow (7 weeks) and one wider (14 weeks) definition) in the Swedish population-based bladder cancer research-database (BladderBaSe) were studied. DSS and OS after radical cystectomy during holiday periods were analysed with Cox regression models adjusted for sex, age, comorbidity, marital status, T-stage and nodal metastases, neoadjuvant chemotherapy, hospital volume and year of cystectomy. Results Surgery during the holiday periods (narrow and wide definitions) were not associated with DSS (Hazard ratio [HR] = 1.05, 95% confidence interval [95% CI] = 0.90–1.21 and HR = 1.04, 95% CI = 0.91–1.17), respectively. HRs for OS were similar, and no associations between radical cystectomy during any of the holiday period definitions and 90-day mortality and readmission were found. Conclusion Survival after radical cystectomy in Sweden is similar during holiday and non-holiday periods.

P0172 - Febrile urinary tract infection as a cause for 90-day readmission after radical cystectomy for bladder cancer: Microbiology and risk factors

P0172 - Febrile urinary tract infection as a cause for 90-day readmission after radical cystectomy for bladder cancer: Microbiology and risk factors

Narrative review of the surgical management of high-risk upper tract urothelial carcinoma

: Upper tract urothelial carcinoma (UTUC) consist of malignancies arising from the urothelium of the collecting system including the renal calyces, renal pelvis down to the level of the distal ureter. High-risk disease consists of any of the following characteristics including (I) the presence of hydronephrosis, (II) tumor size greater than 2 cm, (III) high-grade cytology, (IV) high-grade pathological biopsy, (V) multifocal disease, (VI) previous radical cystectomy for bladder cancer, and (VII) variant histology. The standard surgical management for high-risk disease is radical nephroureterectomy (RNU) with regional lymph node dissection (LND) and bladder cuff excision. This treatment may be performed via an open, laparoscopic, or robotic-assisted laparoscopic approach with varying levels of potential morbidity. Regional LND plays an important prognostic role at the time of RNU in terms of improving staging accuracy for possible early adjuvant therapy. A single instillation of intravesical chemotherapy post-RNU can also help reduce bladder tumor recurrences in the postoperative period regardless of surgical technique. Neoadjuvant or adjuvant chemotherapy can further enhance oncological outcomes with this disease although there is a push toward neoadjuvant therapy due to loss of a renal unit and reduced renal function precluding some patients from adjuvant therapy. Further clinical trials are needed to examine the effects of immunotherapy in the multi-disciplinary treatment of this disease. In the review, we summarize the various surgical treatment options available for high-risk UTUC.

V43 - The impact of previous prostate surgery on surgical outcomes in patients treated with robot-assisted radical cystectomy for bladder cancer

V43 - The impact of previous prostate surgery on surgical outcomes in patients treated with robot-assisted radical cystectomy for bladder cancer

The role of 18F-FDG PET/CT scan compared to CT-scan alone for lymph node staging before radical cystectomy in patients with bladder cancer

BackgroundAccurate Lymph node (LN) staging before radical cystectomy (RC) in patients with bladder cancer (BC) is crucial to improve patient's management. 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET-CT) become widely used in the loco-regional staging of BC. The diagnostic performance of PET-CT in preoperative LN staging of BC is still unknown due to lacking large trials. ObjectivesWe aim to evaluate the diagnostic value of PET-CT scan, compared with CT scan alone for preoperative LN staging of BC. Patients and methodsFrom January 2010 to November 2020, we retrospectively reviewed the records of 300 patients undergoing RC for muscle-invasive BC and high-risk non-muscle-invasive BC. All patients had PET-CT and CT of abdomen and pelvis to assess for pelvic LN metastases before RC. Patients were excluded from analysis if they had neoadjuvant chemotherapy (NAC). Sensitivity, specificity, and accuracy for detecting pelvic LN metastases were determined by comparing the results of the FDG PET-CT and CT alone to the final histopathology reports obtained after RC. ResultsLN metastasis was confirmed histology in 134 patients (44.7%). On a patient-based analysis, PET–CT, and CT showed a sensitivity of 40.3% and 13.4 %, respectively, a specificity of 79.5% and 86.7 %, respectively, positive predictive value (PPV) of 61.4% and 45%, respectively, and negative predictive value (NPV) of 62.3% and 55.4%, respectively. The diagnostic accuracy of PET-CT scan depends on multiple preoperative and postoperative factors. ConclusionPET-CT is more accurate than CT-scan alone for preoperative LN staging in patients with BC.

Impact of preoperative plasma levels of interleukin 6 and interleukin 6 soluble receptor on disease outcomes after radical cystectomy for bladder cancer

BackgroundPreoperative plasma levels of Interleukin 6 (IL6) and its soluble receptor (IL6sR) have previously been associated with oncologic outcomes in urothelial carcinoma of the bladder (UCB); however, external validation in patients treated with radical cystectomy (RC) for UCB is missing.Patients/methodsWe prospectively collected preoperative plasma from 1,036 consecutive patients at two institutes. These plasma specimens were assessed for levels of IL6 and IL6sR. Logistic and Cox regression analyses were used to assess the correlation of plasma levels with pathologic and survival outcomes. The additional clinical net benefits of preoperative IL6 and IL6sR were evaluated using decision curve analysis (DCA).ResultsMedian IL6 and IL6sR plasma levels were significantly higher in patients with adverse pathologic features. Elevated biomarker levels were independently associated with an increased risk for lymph node metastasis and ≥ pT3 disease. Both biomarkers were independently associated with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). The addition to, respectively, fitted pre- and postoperative prognostic models improved the predictive accuracy for lymph node metastasis, ≥ pT3 disease, RFS and CSS on DCA.InterpretationWe confirmed that elevated preoperative plasma levels of IL6 and IL6sR levels are associated with worse oncological disease survival in patients treated with RC for UCB in a large multicenter study. Both biomarkers hold potential in identifying patients with adverse pathological features that may benefit from intensified/multimodal therapy and warrant inclusion into predictive/prognostic models. They demonstrated the ability to improve the discriminatory power of such models and thus guide clinical decision making.

Preoperative Serum Gamma-Glutamyltransferase as a Prognostic Biomarker in Patients Undergoing Radical Cystectomy for Bladder Cancer.

BackgroundSerum gamma-glutamyltransferase (GGT) has been reported to be correlated with survival in a variety of malignancies. However, its effect on patients with bladder cancer (BC) treated by radical cystectomy has never been evaluated.Patients and MethodsWe retrospectively evaluated 263 patients who underwent radical surgery in our center. Baseline features, hematologic variables, and follow-up data were obtained. The endpoints included overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). The relationship between GGT and survival were evaluated.ResultsThe median follow-up period for all patients was 34.7 (22.9-45.9) months. At the last follow-up, 67 patients died, 51 patients died of cancer, 92 patients experienced disease recurrence. Patients with an elevated serum GGT had a higher rate of pT3-T4 tumors. Patients with a higher preoperative serum GGT had a lower rate of OS, CSS and DFS (P < 0.001 for all). Multivariate analysis identified that preoperative serum GGT was independent predictor of OS (HR: 3.027, 95% CI: 1.716-5.338; P < 0.001), CSS (HR: 2.115, 95% CI: 1.093-4.090; P = 0.026), DFS (HR: 2.584, 95% CI: 1.569-4.255; P < 0.001). Age, diabetes history, pathologic T stage, and lymph node status also were independent predictors of prognosis for BC patients.ConclusionsOur results indicated that preoperative serum GGT was an independent prognosis predictor for survival of BC patients after radical cystectomy, and can be included in the prognostic models.

Validation of the COBRA nomogram for the prediction of cancer specific survival in patients treated with radical cystectomy for bladder cancer: An international wide cohort study

BackgroundRecently, the Cancer of the Bladder Risk Assessment (COBRA) score has been introduced to estimate cancer specific survival (CSS) after radical cystectomy for bladder cancer. ObjectivesAim of our study was to validate the COBRA score, assessing the effect of age, tumor stage and lymph-nodes status on CSS after cystectomy in patients with bladder cancer. Design, setting, and participantsA consecutive series of 2395 patients with primitive or recurrent bladder cancer treated with radical cystectomy in 4 centers were evaluated. Outcome measurements and statistical analysisThe role of COBRA score as predictor of CSS was assessed using the Kaplan Meier and Cox proportional hazards analyses. Accuracy of COBRA score was evaluated by Harrell's C test. Results and limitationsMedian age was 66 (IQR 58/73) years. Overall, at a median follow-up of 48 (IQR 22/92) months, 642 patients (27%) died of bladder cancer. On Cox proportional hazards analyses, COBRA score was a significant predictor of CSS (HR 1.54, 95%CI 1.47–1.61) (Table 1). The predictive accuracy of the COBRA score was 0.71. A sub analysis including pooled COBRA score (0 vs 1–3 vs 4 vs 5–7) improved the clinical applicability with the same accuracy. ConclusionIn our experience, the COBRA score is an excellent tool to predict cancer specific survival. The COBRA Score represents a practical and easy tool that may help urologists to classify the CSS of patients treated with radical cystectomy, to predict the oncological outcome and finally to counsel bladder cancer patients.

Morbidity and Days Alive and Out of Hospital Within 90 Days Following Radical Cystectomy for Bladder Cancer

BackgroundMorbidity after radical cystectomy (RC) is usually quantified in terms of rates of complications, mortality, reoperations, and readmissions, and length of stay (LOS). The overall burden following RC within the first 90 d following RC may be better described using days alive and out of hospital (DAOH), which is a validated, patient-centred proxy for both morbidity and mortality. ObjectiveTo report short-term morbidity, LOS, and DAOH within 90 d after RC and risk factors associated with these parameters. Design, setting and participantsThe study included 729 patients undergoing RC for bladder cancer at a single academic centre from 2009 to 2019. Data were retrieved from national electronic medical charts. Outcome measurements and statistical analysisMultivariate analysis was used to investigate variables associated with a major complication, LOS >7 d, and DAOH <80 d. Results and limitationsThe 90-d complication rate was 80%, including major complications in 37% of cases. Median LOS was 7 d (interquartile range (IQR) 6–9) and median DAOH was 80 d (IQR 71–83) days. Body mass index and the Charlson comorbidity index (CCI) predicted major complications. CCI predicted LOS >7 d and DAOH <80 d. ConclusionsRC was associated with significant short-term morbidity and DAOH was a good marker for cumulative morbidity after RC. We propose that DAOH should be a standard supplement for reporting surgical outcomes following RC for bladder cancer, which may facilitate better comparison of outcomes across treating institutions. Patient summaryWe studied complications after surgical removal of the bladder for bladder cancer. We assessed a novel patient-centred tool that more accurately describes the total burden of complications after surgery than traditional models. We found that patients with a high body mass index and coexisting chronic diseases had a higher risk of a complicated surgical course.

Prognostic Impact of AHNAK2 Expression in Patients Treated with Radical Cystectomy.

Simple SummaryUnfavorable results following radical cystectomy for bladder cancer (BCa) highlights a critical need for a novel prognostic molecular biomarker with potential therapeutic benefits. In the present study, the expression levels of AHNAK2 in specimens obtained by radical cystectomy were classified as “low expression” or “high expression” by immunohistochemical staining. Then, we retrospectively evaluated associations between the two AHNAK2 expression patterns and the prognoses in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS). Our multivariate analysis, adjusting for the effects of clinicopathological features, showed that the high expression level of AHNAK2 was an independent risk factor for RFS and CSS. The present study showed that AHNAK2 acts as a novel prognostic biomarker in patients with radical cystectomy for BCa.Data regarding expression levels of AHNAK2 in bladder cancer (BCa) have been very scarce. We retrospectively reviewed clinical data including clinicopathological features in 120 patients who underwent radical cystectomy (RC) for BCa. The expression levels of AHNAK2 in the specimens obtained by RC were classified as low expression (LE) or high expression (HE) by immunohistochemical staining. Statistical analyses were performed to compare associations between the two AHNAK2 expression patterns and the prognoses in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS). A Kaplan–Meier analysis showed that patients with HE had a significantly worse RFS and CSS than those with LE (hazard ratio [HR]: 1.78, 95% confidence interval [CI]: 1.02–2.98, p = 0.027 and HR: 1.91, 95% CI: 1.08–3.38, p = 0.023, respectively). In a multivariate analysis, independent risk factors for worse RFS and CSS were shown as HE (HR: 1.96, 95% CI: 1.08–3.53, p = 0.026 and HR: 2.22, 95% CI: 1.14–4.31, p = 0.019, respectively) and lymph node metastasis (HR: 2.04, 95% CI: 1.09–3.84, p = 0.026 and HR: 1.19, 95% CI: 1.25–4.97, p = 0.009, respectively). The present study showed that AHNAK2 acts as a novel prognostic biomarker in patients with RC for BCa.

Impact of preoperative sarcopenia and myosteatosis on prognosis after radical cystectomy in patients with bladder cancer.

To evaluate the prognostic impact of sarcopenia and myosteatosis on survival after radical cystectomy for bladder cancer. We retrospectively reviewed consecutive patients who underwent radical cystectomy for bladder cancer between 2010 and 2019, and 123 patients were finally included in this single-center study. Pretreatment computed tomography images at the L3 level were used to calculate skeletal muscle index and skeletal muscle density. Sarcopenia and myosteatosis were diagnosed according to the gender-specific cutoff values of skeletal muscle index and skeletal muscle density used in a previous study. We compared overall survival and cancer-specific survival between patients with and without sarcopenia/myosteatosis. We also performed Cox proportional regression analyses to identify the predictors of overall survival and cancer-specific survival. The median patient age was 74years, and 20 patients (16%) were female. Thirty-eight patients (31%) died from bladder cancer and 13 (11%) died from other causes. The patients with sarcopenia (n=48, 39%) and those with myosteatosis (n=101, 82%) had significantly lower overall survival and cancer-specific survival rates than those without sarcopenia and those without myosteatosis, respectively. In multivariable analysis, in addition to the number of pathological risk factors, both sarcopenia (P<0.01) and myosteatosis (P=0.04) were independent significant predictors of poor cancer-specific survival. In our experience, sarcopenia and myosteatosis are independent predictors of poor cancer-specific survival in patients undergoing radical cystectomy for bladder cancer. Sarcopenia is also associated with poor overall survival.

AUTHOR REPLY

Optimizing pelvic health outcomes for women undergoing radical cystectomy for bladder cancer is an important component of preserving quality of life and should be a priority. As many high-volume urologic centers now include a fellowship trained specialist in female pelvic medicine and reconstructive surgery, a comprehensive approach to care, integrating the critical components of maximizing oncologic success with the important factors to minimize side effects and bother, can be discussed in management conferences, executed in operating theaters, taught to our trainees, and studied systematically.