Background:Sarcopenia is a recognized adverse prognostic factor in many cancers and can be reliably assessed using computed tomography (CT) scans. Its prognostic value in bladder cancer patients undergoing neoadjuvant chemotherapy remains underexplored. This study aimed to assess sarcopenia’s impact on survival and compare different measurement thresholds.Methods:We conducted a retrospective multicenter study including patients with invasive urothelial carcinoma treated with neoadjuvant chemotherapy followed by cystectomy between 2015 and 2021. Sarcopenia was assessed by measuring the Skeletal Muscle Index on CT scans before chemotherapy (BC) and prior to surgery (BS). The primary endpoint was overall survival. Secondary endpoints included progression-free survival (PFS), pathological complete response (pCR), and treatment-related complications.Results:Seventy-four patients were included, the majority receiving the MVAC regimen (71.7%). Forty percent of patients achieved a pCR, 35% experienced disease recurrence, and the median PFS was 25 months. Sarcopenia was observed in 27% of patients BC and in 39% BS. Sarcopenia was associated with an increased risk of all-cause mortality: BC according to the definition by Martin et al. (HR 3.38; 95% CI [1.25–9.12];p= 0.016) and Fearon et al. (HR 4.03; 95% CI [1.13–14.3];p= 0.031); and BS according to Martin et al. (HR 3.7; 95% CI [1.12–12.2];p= 0.032) and Fearon et al. (HR 6.08; 95% CI [1.48–24.9];p= 0.012). Sarcopenia was an independent risk factor of shorter PFS.Conclusions:Sarcopenia represent an independent and reproducible prognostic factor for mortality in patients with bladder cancer. The study is the first study to compare threshold values at different time points.
背景：肌肉减少症是许多癌症公认的不良预后因素，可通过计算机断层扫描（CT）可靠评估。其在接受新辅助化疗的膀胱癌患者中的预后价值尚未得到充分探索。本研究旨在评估肌肉减少症对生存率的影响，并比较不同的测量阈值。
方法：我们进行了一项回顾性多中心研究，纳入2015年至2021年间接受新辅助化疗后行膀胱切除术的侵袭性尿路上皮癌患者。通过测量化疗前（BC）和手术前（BS）CT扫描的骨骼肌指数来评估肌肉减少症。主要终点为总生存期。次要终点包括无进展生存期（PFS）、病理完全缓解（pCR）和治疗相关并发症。
结果：共纳入74例患者，多数接受MVAC方案（71.7%）。40%的患者达到pCR，35%出现疾病复发，中位PFS为25个月。27%的患者在化疗前存在肌肉减少症，39%在手术前存在肌肉减少症。肌肉减少症与全因死亡风险增加相关：根据Martin等人的定义（BC：HR 3.38；95% CI [1.25–9.12]；p=0.016）和Fearon等人的定义（BC：HR 4.03；95% CI [1.13–14.3]；p=0.031）；根据Martin等人的定义（BS：HR 3.7；95% CI [1.12–12.2]；p=0.032）和Fearon等人的定义（BS：HR 6.08；95% CI [1.48–24.9]；p=0.012）。肌肉减少症是较短PFS的独立危险因素。
结论：肌肉减少症是膀胱癌患者死亡的一个独立且可重复的预后因素。本研究首次比较了不同时间点的阈值。
Sarcopenia Predicts Mortality in Bladder Cancer with Neoadjuvant Chemotherapy: A Multicenter Study
肿瘤(癌症)患者之家