International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 338–346 | Cite as

Significance of sarcopenia as a prognostic factor for metastatic urothelial carcinoma patients treated with systemic chemotherapy

  • Hideyuki AbeEmail author
  • Kohei Takei
  • Toshitaka Uematsu
  • Yuumi Tokura
  • Issei Suzuki
  • Kazumasa Sakamoto
  • Daisaku Nishihara
  • Yoshiyuki Yamaguchi
  • Tomoya Mizuno
  • Akinori Nukui
  • Minoru Kobayashi
  • Takao Kamai
Original Article



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.


Sarcopenia Body mass index Muscle area Urothelial carcinoma Chemotherapy Prognosis 



Gemcitabine plus cisplatin


Gemcitabine plus carboplatin


Computed tomography


Skeletal muscle index


Paraspinal muscle index


Total psoas area


Overall survival


Confidence interval


Body mass index


European Working Group on Sarcopenia in Older People


Urothelial carcinoma


Methotrexate, vinblastine, doxorubicin and cisplatin


Metastatic urothelial carcinoma


Eastern Cooperative Oncology Group performance status


Lymphovascular invasion


C-reactive protein


Glasgow prognostic score


Third lumber vertebra


Interquartile range


Dual-energy X-ray absorptiometry


Computed tomography


Magnetic resonance imaging


Cardiovascular disease



The authors are grateful to Dr. Ken-Ichiro Yoshida and Dr. Kyoko Arai for constructive suggestions, ServiceScape ( and Jessica McHale ( for English language editing.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Hideyuki Abe
    • 1
    Email author
  • Kohei Takei
    • 1
  • Toshitaka Uematsu
    • 1
  • Yuumi Tokura
    • 1
  • Issei Suzuki
    • 1
  • Kazumasa Sakamoto
    • 1
  • Daisaku Nishihara
    • 2
  • Yoshiyuki Yamaguchi
    • 1
  • Tomoya Mizuno
    • 3
  • Akinori Nukui
    • 1
  • Minoru Kobayashi
    • 4
  • Takao Kamai
    • 1
  1. 1.Department of UrologyDokkyo Medical UniversityMibu-ShimotsugaJapan
  2. 2.Department of UrologyYuai Memorial HospitalKogaJapan
  3. 3.Department of UrologyNasu Red Cross HospitalOotawaraJapan
  4. 4.Department of UrologyUtsunomiya Memorial HospitalUtsunomiyaJapan

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