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Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We aimed to describe the effect of preoperative sarcopenia on oncologic outcomes of organ-confined renal cell carcinoma (RCC) after radical nephrectomy.

Patients and Methods

A total of 632 patients with pT1–2 RCC who underwent radical nephrectomy between 2004 and 2014 were retrospectively analyzed. From preoperative computerized tomography (CT) scans, skeletal muscle index (SMI) was measured and gender-specific cutoff values at third lumbar vertebra of 52.4 cm2/m2 for men and 38.5 cm2/m2 for women were used to define sarcopenia. Survivals were compared and associations with sarcopenia were analyzed using Kaplan–Meier log rank tests and Cox proportional hazard regression models. Median follow-up was 83 months.

Results

Of 632 patients, 268 (42.4%) were classified as sarcopenic. The sarcopenic group was more advanced in age (57 versus 53 years) and more predominantly male (71.3% versus 59.9%). Sarcopenic patients had lower body mass index (BMI, 23.0 versus 25.9 kg/m2), but there was no difference in tumor size, stage, or nuclear grade. Sarcopenia was associated with poorer overall survival (OS) and cancer-specific survival (CSS; OS 94.0% versus 82.1%; p < 0.001 and CSS 97.5% versus 91.8%; p < 0.001). On multivariate analysis, sarcopenia was an independent risk factor for all-cause mortality [hazard ratio (HR) 2.58; 95% CI 1.02–6.54] and cancer-specific mortality (HR 3.07; 95% CI 1.38–6.83).

Conclusions

Sarcopenia at diagnosis was an independent risk factor for all-cause and cancer-specific mortality after radical nephrectomy for pT1–2 RCC. These findings underscore the importance of assessing presence of sarcopenia for risk stratification even among surgical candidates.

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Abbreviations

BMI:

Body mass index

CSS:

Cancer-specific survival

CT:

Computed tomography

OS:

Overall survival

PFS:

Progression-free survival

RCC:

Renal cell carcinoma

SMI:

Skeletal muscle index

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Acknowledgments

Source of Funding: None. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Author notes

  1. Co-first authors: Jongpil Lee and Jungyo Suh

Authors and Affiliations

  1. Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

    Jongpil Lee MD, Jungyo Suh MD, Cheryn Song MD, PhD, MPH, Dalsan You MD, PhD, In Gab Jeong MD, PhD, Bumsik Hong MD, PhD, Jun Hyuk Hong MD, PhD, Choung Soo Kim MD, PhD & Hanjong Ahn MD, PhD

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  1. Jongpil Lee MD
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  2. Jungyo Suh MD
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  3. Cheryn Song MD, PhD, MPH
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  4. Dalsan You MD, PhD
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Contributions

J.L.: data curation, formal analysis, and writing—original draft preparation. J.S.: statistical analysis, and revision draft preparation. C.S.: conceptualization, methodology, supervision, and writing—reviewing and editing. D.Y.: Methodology. I.G.J.: conceptualization. B.H.: methodology. J.H.H.: supervision. C.S.K.: validation. H.A.: conceptualization, validation, supervision, and visualization.

Corresponding author

Correspondence to Cheryn Song MD, PhD, MPH.

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Supplementary Information

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Supplementary Figure 1. Patient selection flow for the analysis. Supplementary file 1 (TIF 45 kb)

10434_2021_10881_MOESM2_ESM.tif

Supplementary Figure 2. Examples of lumbar skeletal muscle measured on preoperative CT scans. Supplementary file 2 (TIF 944 kb)

10434_2021_10881_MOESM3_ESM.jpg

Supplementary Figure 3. Cumulative risk of all-cause mortality according to sarcopenic status. Supplementary file 3 (JPG 53 kb)

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Lee, J., Suh, J., Song, C. et al. Association Between Sarcopenia and Survival of Patients with Organ-Confined Renal Cell Carcinoma after Radical Nephrectomy. Ann Surg Oncol 29, 2473–2479 (2022). https://doi.org/10.1245/s10434-021-10881-7

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  • DOI: https://doi.org/10.1245/s10434-021-10881-7

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