Objective: To evaluate the impact of body composition parameters, including specifically sarcopenic obesity (SO), on postoperative and oncological outcomes in patients undergoing radical cystectomy (RC) for bladder cancer, thereby addressing a paucity of data in this setting. Methods: A retrospective observational study was conducted in patients who underwent RC. Preoperative CT scans were analyzed using semi-automatic segmentation software to assess body composition parameters, with measurements of adipose and muscle tissue obtained at the level of the L3 vertebra. Results: A total of 249 patients were included, of whom 127 (52.5%) met the criteria for sarcopenia, 53 (21.3%) for obesity, and 14 (5.6%) for SO. Multivariate analysis identified previous abdominal surgery (OR 2.56, 95% CI 1.24–5.23,p= 0.011), total serum protein level (OR 0.57, 95% CI 0.36–0.88,p= 0.013), and SO (OR 7.01, 95% CI 1.06–37.05,p= 0.045) as independent predictors of 90-day postoperative complications. Patients with SO experienced significantly higher rates of abdominal wall complications (p= 0.03). However, in multivariate analyses, SO was not associated with overall survival (despite apvalue of 0.04 at univariate analysis), cancer-specific survival, or progression-free survival. Conclusions: Preoperative CT-based assessment of body composition is a valuable tool in the surgical evaluation of patients undergoing RC. SO appears to be an independent predictor of short-term postoperative complications and should be considered when planning prehabilitation strategies.
目的：评估身体成分参数，特别是肌肉减少性肥胖（SO），对接受根治性膀胱切除术（RC）的膀胱癌患者术后及肿瘤学结局的影响，以弥补该领域数据不足的现状。方法：对接受RC的患者进行回顾性观察研究。利用半自动分割软件分析术前CT扫描，评估身体成分参数，测量L3椎体水平的脂肪和肌肉组织。结果：共纳入249例患者，其中127例（52.5%）符合肌肉减少症标准，53例（21.3%）符合肥胖标准，14例（5.6%）符合SO标准。多变量分析显示，既往腹部手术史（OR 2.56，95% CI 1.24–5.23，p=0.011）、血清总蛋白水平（OR 0.57，95% CI 0.36–0.88，p=0.013）及SO（OR 7.01，95% CI 1.06–37.05，p=0.045）是术后90天并发症的独立预测因素。SO患者腹壁并发症发生率显著更高（p=0.03）。然而，在多变量分析中，SO与总生存期（尽管单变量分析p值为0.04）、癌症特异性生存期或无进展生存期均无显著关联。结论：基于术前CT的身体成分评估是RC患者手术评估的重要工具。SO似乎是术后短期并发症的独立预测因素，应在制定预康复策略时予以考虑。
肿瘤(癌症)患者之家