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

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.

Keywords

Sarcopenia Body mass index Muscle area Urothelial carcinoma Chemotherapy Prognosis 

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

Notes

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.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.

References

  1. 1.
    Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127(5 Suppl):990S–991SCrossRefPubMedGoogle Scholar
  2. 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):412–423CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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):2910–2918CrossRefPubMedGoogle Scholar
  4. 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):1478–1486CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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):26–32CrossRefPubMedGoogle Scholar
  6. 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):1034–1041CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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):1594–1598CrossRefPubMedGoogle Scholar
  8. 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):931–936CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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):1714–1720CrossRefPubMedGoogle Scholar
  10. 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):884–891CrossRefPubMedGoogle Scholar
  11. 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):4602–4608CrossRefPubMedGoogle Scholar
  12. 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):2432–2438CrossRefPubMedGoogle Scholar
  13. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495CrossRefPubMedGoogle Scholar
  15. 15.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458CrossRefPubMedGoogle Scholar
  16. 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):2333–2338CrossRefPubMedGoogle Scholar
  17. 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):997–1006CrossRefPubMedGoogle Scholar
  18. 18.
    Fortin M, Battie MC (2012) Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther 92(6):853–864CrossRefPubMedGoogle Scholar
  19. 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):439–446CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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):237–243CrossRefPubMedGoogle Scholar
  21. 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):1593–1602CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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):345–353CrossRefPubMedGoogle Scholar
  23. 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):999–1005CrossRefPubMedGoogle Scholar
  24. 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. 25.
    Wannamethee SG, Atkins JL (2015) Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc 74(4):405–412CrossRefPubMedGoogle Scholar
  26. 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):629–635CrossRefPubMedGoogle Scholar
  27. 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):74–87CrossRefPubMedPubMedCentralGoogle Scholar
  28. 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):702–715CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Friedenreich CM, Wang Q, Neilson HK et al (2016) Physical activity and survival after prostate cancer. Eur Urol 70(4):576–585CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Hideyuki Abe
    • 1
  • 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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