Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

GC:

Gemcitabine plus cisplatin

GCb:

Gemcitabine plus carboplatin

CT:

Computed tomography

SMI:

Skeletal muscle index

PSMI:

Paraspinal muscle index

TPA:

Total psoas area

OS:

Overall survival

CI:

Confidence interval

BMI:

Body mass index

EWGSOP:

European Working Group on Sarcopenia in Older People

UC:

Urothelial carcinoma

MVAC:

Methotrexate, vinblastine, doxorubicin and cisplatin

mUC:

Metastatic urothelial carcinoma

ECOG PS:

Eastern Cooperative Oncology Group performance status

LVI:

Lymphovascular invasion

CRP:

C-reactive protein

GPS:

Glasgow prognostic score

L3:

Third lumber vertebra

IQR:

Interquartile range

DXA:

Dual-energy X-ray absorptiometry

CT:

Computed tomography

MRI:

Magnetic resonance imaging

CVD:

Cardiovascular disease

References

  1. Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127(5 Suppl):990S–991S

    Article  CAS  PubMed  Google Scholar 

  2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in older people. Age Ageing 39(4):412–423

    Article  PubMed  PubMed Central  Google Scholar 

  3. Psutka SP, Carrasco A, Schmit GD et al (2014) Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality. Cancer 120(18):2910–2918

    Article  PubMed  Google Scholar 

  4. Peng P, Hyder O, Firoozmand A et al (2012) Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg 16(8):1478–1486

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fukushima H, Nakanishi Y, Kataoka M et al (2016) Prognostic significance of sarcopenia in patients with metastatic renal cell carcinoma. J Urol 195(1):26–32

    Article  PubMed  Google Scholar 

  6. Huillard O, Mir O, Peyromaure M et al (2013) Sarcopenia and body mass index predict sunitinib-induced early dose-limiting toxicities in renal cancer patients. Br J Cancer 108(5):1034–1041

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Antoun S, Baracos VE, Birdsell L et al (2010) Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol 21(8):1594–1598

    Article  CAS  PubMed  Google Scholar 

  8. Lieffers JR, Bathe OF, Fassbender K et al (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107(6):931–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Smith AB, Deal AM, Yu H et al (2014) Sarcopenia as a predictor of complications and survival following radical cystectomy. J Urol 191(6):1714–1720

    Article  PubMed  Google Scholar 

  10. Hori M, Matsuda T, Shibata A et al (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45(9):884–891

    Article  PubMed  Google Scholar 

  11. von der Maase H, Sengelov L, Roberts JT et al (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23(21):4602–4608

    Article  PubMed  Google Scholar 

  12. Galsky MD, Hahn NM, Rosenberg J et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for Cisplatin-based chemotherapy. J Clin Oncol 29(17):2432–2438

    Article  PubMed  Google Scholar 

  13. Fukushima H, Yokoyama M, Nakanishi Y et al (2015) Sarcopenia as a prognostic biomarker of advanced urothelial carcinoma. PLoS One 10(1):e0115895. https://doi.org/10.1371/journal.pone.0115895

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495

    Article  PubMed  Google Scholar 

  15. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458

    Article  CAS  PubMed  Google Scholar 

  16. Shen W, Punyanitya M, Wang Z et al (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97(6):2333–2338

    Article  PubMed  Google Scholar 

  17. Mourtzakis M, Prado CM, Lieffers JR et al (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33(5):997–1006

    Article  PubMed  Google Scholar 

  18. Fortin M, Battie MC (2012) Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther 92(6):853–864

    Article  PubMed  Google Scholar 

  19. Peng PD, van Vledder MG, Tsai S et al (2011) Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB 13(7):439–446

    Article  PubMed  PubMed Central  Google Scholar 

  20. Taguchi S, Akamatsu N, Nakagawa T et al (2016) Sarcopenia evaluated using the skeletal muscle index is a significant prognostic factor for metastatic urothelial carcinoma. Clin Genitourin Cancer 14(3):237–243

    Article  PubMed  Google Scholar 

  21. Amini N, Spolverato G, Gupta R et al (2015) Impact total psoas volume on short- and long-term outcomes in patients undergoing curative resection for pancreatic adenocarcinoma: a new tool to assess sarcopenia. J Gastrointest Surg 19(9):1593–1602

    Article  PubMed  PubMed Central  Google Scholar 

  22. Angeras O, Albertsson P, Karason K et al (2013) Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J 34(5):345–353

    Article  PubMed  Google Scholar 

  23. Gonzalez MC, Pastore CA, Orlandi SP et al (2014) Obesity paradox in cancer: new insights provided by body composition. Am J Clin Nutr 99(5):999–1005

    Article  CAS  PubMed  Google Scholar 

  24. Caan BJ, Meyerhardt JA, Kroenke CH et al (2017) Explaining the obesity paradox: the association between body composition and colorectal cancer survival (C-SCANS Study). Cancer Epidemiol Biomarkers Prev. https://doi.org/10.1158/1055-9965.EPI-17-0200

    Google Scholar 

  25. Wannamethee SG, Atkins JL (2015) Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc 74(4):405–412

    Article  PubMed  Google Scholar 

  26. Prado CM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–635

    Article  PubMed  Google Scholar 

  27. Palmela C, Velho S, Agostinho L et al (2017) Body composition as a prognostic factor of neoadjuvant chemotherapy toxicity and outcome in patients with locally advanced gastric cancer. J Gastric Cancer 17(1):74–87

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hall DT, Ma JF, Marco SD et al (2011) Inducible nitric oxide synthase (iNOS) in muscle wasting syndrome, sarcopenia, and cachexia. Aging 3(8):702–715

    Article  PubMed  PubMed Central  Google Scholar 

  29. Friedenreich CM, Wang Q, Neilson HK et al (2016) Physical activity and survival after prostate cancer. Eur Urol 70(4):576–585

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Urology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Shimotsuga, Tochigi, 321-0293, Japan

    Hideyuki Abe, Kohei Takei, Toshitaka Uematsu, Yuumi Tokura, Issei Suzuki, Kazumasa Sakamoto, Yoshiyuki Yamaguchi, Akinori Nukui & Takao Kamai

  2. Department of Urology, Yuai Memorial Hospital, 707 Higashiushigaya, Koga, Ibaraki, 306-0232, Japan

    Daisaku Nishihara

  3. Department of Urology, Nasu Red Cross Hospital, 1081-4, Nakatawara, Ootawara, Tochigi, 324-8686, Japan

    Tomoya Mizuno

  4. Department of Urology, Utsunomiya Memorial Hospital, 1-3-16 Ohdoori, Utsunomiya, Tochigi, 320-0811, Japan

    Minoru Kobayashi

Authors
  1. Hideyuki Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kohei Takei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshitaka Uematsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuumi Tokura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Issei Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazumasa Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daisaku Nishihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshiyuki Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoya Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akinori Nukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Minoru Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takao Kamai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideyuki Abe.

Ethics declarations

Conflict of interest

All authors have no conflict of interest to declare.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abe, H., Takei, K., Uematsu, T. et al. Significance of sarcopenia as a prognostic factor for metastatic urothelial carcinoma patients treated with systemic chemotherapy. Int J Clin Oncol 23, 338–346 (2018). https://doi.org/10.1007/s10147-017-1207-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-017-1207-x

Keywords

Search

Navigation