Medical Oncology

, 36:7 | Cite as

Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer

  • Kazutaka Okita
  • Shingo HatakeyamaEmail author
  • Naoki Fujita
  • Sakae Konishi
  • Hayato Yamamoto
  • Atsushi Imai
  • Takahiro Yoneyama
  • Yasuhiro Hashimoto
  • Hiroyuki Ito
  • Kazuaki Yoshikawa
  • Takuya Koie
  • Chikara Ohyama
Original Paper


We aimed to investigate the impact of postoperative weight loss following radical cystectomy (RC) on patients’ prognoses. RC and urinary diversion were performed in 512 consecutive patients with muscle-invasive bladder cancer at our hospitals between May 1996 and July 2018. Demographic clinical information, pre- and postoperative serum albumin, hemoglobin, and weight were evaluated retrospectively at 1 month. We also evaluated the association of weight loss with complications and overall survival (OS) as estimated using the Kaplan–Meier method and compared using the log-rank test. Risk factors for poor OS were determined by Inverse Probability of Treatment Weighted (IPTW)-adjusted Cox regression analysis. In 385 patients who met the study search criteria, median postoperative weight loss from baseline at 1 week and 1 month was 1.1 (− 1.8%) and 3.2 (− 5.4%) kg, respectively. Patients with significant weight loss (defined as ≥ 7.5% at 1 month) had higher-grade complications within 1 month and had significantly shorter OS than those with weight loss of < 7.5%. Type of urinary diversion, loss of serum albumin, and loss of hemoglobin were not significantly associated with weight loss. IPTW-adjusted Cox regression analysis showed that such significant weight loss was an independent risk factor for poor OS. Weight loss followed by radical cystectomy was significantly associated with poor prognosis in patients with muscle-invasive bladder cancer.


Cystectomy Weight loss Frailty Survival Bladder cancer 



The authors would like to thank Teppei Okamoto, Teppei Matsumoto, Osamu Soma, Itsuto Hamano, Hiromichi Iwamura, Takuma Narita, Yuki Fujita, Yukie Nishizawa, and Satomi Sakamoto for their invaluable support with data collection. The authors would also like to thank Enago ( for English language review.


This work was supported by a Grant-in-Aid for Scientific Research (Grant Nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, 17K16771, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.


  1. 1.
    Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute-lessons to be learned. J Urol. 2006;176(1):161–6. Scholar
  2. 2.
    Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207–12. Scholar
  3. 3.
    Koie T, Ohyama C, Yamamoto H, Hatakeyama S, Kudoh S, Yoneyama T, et al. Minimum incision endoscopic radical cystectomy in patients with malignant tumors of the urinary bladder: clinical and oncological outcomes at a single institution. Eur J Surg Oncol. 2012;38(11):1101–5. Scholar
  4. 4.
    Kanno T, Kobori G, Shibasaki N, Moroi S, Akao T, Yamada H. Laparoscopic intracorporeal ileal conduit after laparoscopic radical cystectomy: a modified technique to facilitate ureteroenteric anastomosis. Int J Urol. 2018. Scholar
  5. 5.
    Koie T, Ohyama C, Yoneyama T, Nagasaka H, Yamamoto H, Imai A, et al. Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes. Int J Med Robot. 2018:e1955.
  6. 6.
    Tyritzis SI, Wiklund NP. Is the open cystectomy era over? An update on the available evidence. Int J Urol. 2018;25(3):187–95. Scholar
  7. 7.
    Inamoto T, Ibuki N, Komura K, Juri H, Yamamoto K, Yamamoto K, et al. Can bladder preservation therapy come to the center stage? Int J Urol. 2018;25(2):134–40. Scholar
  8. 8.
    Vidal A, Arnold N, Vartolomei MD, Kiss B, Burkhard F, Thalmann GN, et al. Oncological and functional outcomes of postoperative total parenteral nutrition after radical cystectomy in bladder cancer patients: a single-center randomized trial. Int J Urol. 2016;23(12):992–9. Scholar
  9. 9.
    Osawa T, Abe T, Takada N, Ito YM, Murai S, Shinohara N. Validation of the nomogram for predicting 90-day mortality after radical cystectomy in a Japanese cohort. Int J Urol. 2018;25(7):699–700. Scholar
  10. 10.
    McDonald ML, Liss MA, Nseyo UU, Gal DB, Kane CJ, Kader AK. Weight loss following radical cystectomy for bladder cancer: characterization and effect on survival. Clin Genitourin Cancer. 2017;15(1):86–92. Scholar
  11. 11.
    Rosenbaum K, Wang J, Pierson RN Jr, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPEN J Parenter Enteral Nutr. 2000;24(2):52–5. Scholar
  12. 12.
    Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2015;44(1):148–52. Scholar
  13. 13.
    Soma O, Hatakeyama S, Okamoto T, Fujita N, Matsumoto T, Tobisawa Y, et al. Clinical implication of a quantitative frailty assessment tool for prognosis in patients with urological cancers. Oncotarget. 2018;9(25).
  14. 14.
    Johnson DC, Riggs SB, Nielsen ME, Matthews JE, Woods ME, Wallen EM, et al. Nutritional predictors of complications following radical cystectomy. World J Urol. 2015;33(8):1129–37. Scholar
  15. 15.
    Momota M, Hatakeyama S, Tokui N, Sato T, Yamamoto H, Tobisawa Y, et al. The impact of preoperative severe renal insufficiency on poor postsurgical oncological prognosis in patients with urothelial carcinoma. Eur Urol Focus. 2018. Scholar
  16. 16.
    Horiguchi H, Yoneyama T, Hatakeyama S, Tokui N, Sato T, Fujita N, et al. Impact of bacillus Calmette–Guerin therapy of upper urinary tract carcinoma in situ: comparison of oncological outcomes with radical nephroureterectomy. Med Oncol. 2018;35(4):41. Scholar
  17. 17.
    Kido K, Hatakeyama S, Fujita N, Yamamoto H, Tobisawa Y, Yoneyama T, et al. Oncologic outcomes for open and laparoscopic radical nephroureterectomy in patients with upper tract urothelial carcinoma. Int J Clin Oncol. 2018. Scholar
  18. 18.
    Koie T, Ohyama C, Hashimoto Y, Hatakeyama S, Yamamoto H, Yoneyama T, et al. Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: a prospective single-arm study. Int J Clin Oncol. 2013;18(4):724–30. Scholar
  19. 19.
    Anan G, Hatakeyama S, Fujita N, Iwamura H, Tanaka T, Yamamoto H, et al. Trends in neoadjuvant chemotherapy use and oncological outcomes for muscle-invasive bladder cancer in Japan: a multicenter study. Oncotarget. 2017;8(49):86130–42. Scholar
  20. 20.
    Koie T, Ohyama C, Yamamoto H, Imai A, Hatakeyama S, Yoneyama T, et al. Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T2 bladder cancer. Med Oncol. 2014;31(5):949. Scholar
  21. 21.
    Li J, Cheng Y, Liu G, Ji Z. The association of pretreatment serum albumin with outcomes in bladder cancer: a meta-analysis. Onco Targets Ther. 2018;11:3449–59. Scholar
  22. 22.
    Hernandez Torres C, Hsu T. Comprehensive geriatric assessment in the older adult with cancer: a review. Eur Urol Focus. 2017;3(4–5):330–9. Scholar
  23. 23.
    Chappidi MR, Kates M, Patel HD, Tosoian JJ, Kaye DR, Sopko NA, et al. Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy. Urol Oncol. 2016;34(6):256 e1–6. Scholar
  24. 24.
    Sato T, Hatakeyama S, Okamoto T, Yamamoto H, Hosogoe S, Tobisawa Y, et al. Slow gait speed and rapid renal function decline are risk factors for postoperative delirium after urological surgery. PLoS ONE. 2016;11(5):e0153961. Scholar
  25. 25.
    Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol. 2015;49(2):133–41. Scholar
  26. 26.
    Rammant E, Decaestecker K, Bultijnck R, Sundahl N, Ost P, Pauwels NS, et al. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil. 2018;32(5):594–606. Scholar
  27. 27.
    Wynter-Blyth V, Moorthy K. Prehabilitation: preparing patients for surgery. BMJ. 2017;358:j3702. Scholar
  28. 28.
    Di Rollo D, Mohammed A, Rawlinson A, Douglas-Moore J, Beatty J. Enhanced recovery protocols in urological surgery: a systematic review. Can J Urol. 2015;22(3):7817–23.PubMedGoogle Scholar
  29. 29.
    Pang KH, Groves R, Venugopal S, Noon AP, Catto JWF. Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol. 2017. Scholar
  30. 30.
    Jensen BT, Lauridsen SV, Jensen JB. Prehabilitation for major abdominal urologic oncology surgery. Curr Opin Urol. 2018;28(3):243–50. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kazutaka Okita
    • 1
  • Shingo Hatakeyama
    • 1
    Email author
  • Naoki Fujita
    • 1
  • Sakae Konishi
    • 1
  • Hayato Yamamoto
    • 1
  • Atsushi Imai
    • 1
  • Takahiro Yoneyama
    • 1
  • Yasuhiro Hashimoto
    • 1
  • Hiroyuki Ito
    • 2
  • Kazuaki Yoshikawa
    • 3
  • Takuya Koie
    • 4
  • Chikara Ohyama
    • 1
  1. 1.Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
  2. 2.Department of UrologyAomori Rosai HospitalHachinoheJapan
  3. 3.Department of UrologyMutsu General HospitalMutsuJapan
  4. 4.Department of UrologyGifu University Graduate School of MedicineHirosakiJapan

Personalised recommendations