Significance of sarcopenia as a prognostic factor for metastatic urothelial carcinoma patients treated with systemic chemotherapy
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Recently, numerous studies have reported an association between sarcopenia and poor outcomes in various kinds of malignancies. We investigated whether sarcopenia predicts the survival of patients with metastatic urothelial carcinoma who underwent systemic chemotherapy.
We reviewed 87 metastatic urothelial carcinoma patients who underwent chemotherapy (gemcitabine plus cisplatin or gemcitabine plus carboplatin for cisplatin-unfit patients) between 2007 and 2015. A computed tomography scan prior to chemotherapy was used for evaluating sarcopenia, and we measured three cross-sectional areas of skeletal muscle at the third lumbar vertebra and calculated the skeletal muscle index (SMI), the paraspinal muscle index (PSMI), and the total psoas area (TPA) of each patient. Predictive values of survival were assessed using Cox regression analysis.
The median overall survival (OS) was 16 months (95% CI 13.5–18). Although SMI alone was not a significant predictor of shorter OS (P = 0.117) in univariate analysis, SMI stratified by the value of the body mass index (BMI) was a significant predictor of shorter OS in univariate analysis (P = 0.037) and was also an independent predictor of shorter OS in multivariate analysis (P = 0.026). PSMI and TPA were not significant prognostic factors even when stratified by BMI (P = 0.294 and 0.448), respectively.
Neither PSMI nor TPA could substitute SMI as a predictor for poor outcomes in metastatic urothelial carcinoma patients treated with systemic chemotherapy in our study. SMI stratified by BMI is a useful predictor of prognosis in these patients.
KeywordsSarcopenia Body mass index Muscle area Urothelial carcinoma Chemotherapy Prognosis
Gemcitabine plus cisplatin
Gemcitabine plus carboplatin
Skeletal muscle index
Paraspinal muscle index
Total psoas area
Body mass index
European Working Group on Sarcopenia in Older People
Methotrexate, vinblastine, doxorubicin and cisplatin
Metastatic urothelial carcinoma
- ECOG PS
Eastern Cooperative Oncology Group performance status
Glasgow prognostic score
Third lumber vertebra
Dual-energy X-ray absorptiometry
Magnetic resonance imaging
The authors are grateful to Dr. Ken-Ichiro Yoshida and Dr. Kyoko Arai for constructive suggestions, ServiceScape (https://www.servicescape.com) and Jessica McHale (http://oe-boston.com) for English language editing.
Compliance with ethical standards
Conflict of interest
All authors have no conflict of interest to declare.