Skip to main content

Advertisement

SpringerLink
Log in

Sarcopenia predicts 90-day mortality and postoperative complications after radical cystectomy for bladder cancer

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

A single-center study was conducted to investigate the impact of sarcopenia as a predictor for 90-day mortality (90 dM) and complications within 90 days after radical cystectomy for bladder cancer.

Methods

In total, 327 patients with preoperative available digital computed tomography (CT) scans of the abdomen and pelvis were identified. The lumbar skeletal muscle index was measured using preoperative abdominal CT to assess sarcopenia. Complications were recorded and graded according to Clavien–Dindo (CD). Predictors of 90 dM and complications within 90 days were analyzed by uni- and multivariable logistic regression.

Results

Of the 327 patients, 262 (80%) were male and 108 (33%) patients were classified as sarcopenic. Within 90 days, 28 (7.8%) patients died, of whom 15 patients were sarcopenic and 13 were not. In multivariable logistic regression analysis, sarcopenia (OR 2.59; 95% CI 1.13–5.95; p = 0.025), ASA 3–4 (OR 2.53; 95% CI 1.10–5.82; p = 0.029) and cM + (OR 7.43; 95% CI 2.34–23.64; p = 0.001) were independent predictors of 90-day mortality. Sarcopenic patients experienced significantly more complications, i.e., CD 4a–5 (p = 0.003), compared to non-sarcopenic patients. In multivariable logistic regression analysis, sarcopenia was independently associated with CD ≥ 3b complications corrected for age, BMI, ASA-Score and type of urinary diversion.

Conclusions

We reported that sarcopenia proved an independent predictor for 90 dM and complications in patients undergoing RC for bladder cancer.

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

Similar content being viewed by others

References

  1. Stein JP et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol Off J Am Soc Clin Oncol 19(3):666–675

    Article  CAS  Google Scholar 

  2. Madersbacher S et al (2003) Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol Off J Am Soc Clin Oncol 21(4):690–696

    Article  Google Scholar 

  3. Aziz A et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66(1):156–163

    Article  PubMed  Google Scholar 

  4. Afshar M et al (2018) Centralisation of radical cystectomies for bladder cancer in England, a decade on from the ‘Improving Outcomes Guidance’: the case for super centralisation. BJU Int 121(2):217–224

    Article  PubMed  CAS  Google Scholar 

  5. Dell’Oglio P et al (2017) Short-form Charlson Comorbidity index for assessment of perioperative mortality after radical cystectomy. J Natl Compr Cancer Netw 15(3):327–333

    Article  Google Scholar 

  6. Novotny V et al (2016) Age, American Society of Anesthesiologists physical status classification and Charlson score are independent predictors of 90-day mortality after radical cystectomy. World J Urol 34(8):1123–1129

    Article  PubMed  Google Scholar 

  7. Mayr R et al (2012) Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJU Int 110:E222–E227

    Article  PubMed  Google Scholar 

  8. Boorjian SA et al (2013) Comparative performance of comorbidity indices for estimating perioperative and 5-year all cause mortality following radical cystectomy for bladder cancer. J Urol 190:55–60

    Article  PubMed  Google Scholar 

  9. Martin L et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–1547

    Article  PubMed  Google Scholar 

  10. Psutka SP 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 

  11. Smith AB et al (2014) Sarcopenia as a predictor of complications and survival following radical cystectomy. J Urol 191(6):1714–1720

    Article  PubMed  Google Scholar 

  12. Hirasawa Y et al (2016) Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy. Ann Surg Oncol 23(Suppl 5):1048–1054

    Article  PubMed  Google Scholar 

  13. Wan F et al (2014) Lower skeletal muscle index and early complications in patients undergoing radical cystectomy for bladder cancer. World J Surg Oncol 12:14

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union against Cancer. TNM classification of malignant tumours. Wiley-Blackwell, W. Sussex

    Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Reisinger KW et al (2014) Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg 261:345–352

    Article  Google Scholar 

  17. Peduzzi P et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379

    Article  PubMed  CAS  Google Scholar 

  18. Sabel MS et al (2011) Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol 18(13):3579–3585

    Article  PubMed  Google Scholar 

  19. Mayr R et al. (2018) Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer. J Cachexia Sarcopenia Muscle

  20. Saitoh-Maeda Y et al (2017) A low psoas muscle volume correlates with a longer hospitalization after radical cystectomy. BMC Urol 17(1):87

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fearon K et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495

    Article  PubMed  Google Scholar 

  22. Fairey A et al (2008) Associations among age, comorbidity and clinical outcomes after radical cystectomy: results from the Alberta Urology Institute radical cystectomy database. J Urol 180(1):128–134

    Article  PubMed  Google Scholar 

  23. Pycha A et al (2008) Comparison of complications in three incontinent urinary diversions. Eur Urol 54(4):825–832

    Article  PubMed  Google Scholar 

  24. Yong C, Daihui C, Bo Z (2017) Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial. Oncotarget 8(16):26565–26572

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cruz-Jentoft AJ 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 

  26. Morley JE et al (2010) Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 11(6):391–396

    Article  PubMed  PubMed Central  Google Scholar 

  27. Peterson MD, Sen A, Gordon PM (2011) Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc 43(2):249–258

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fukuda Y et al (2016) Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer 19(3):986–993

    Article  PubMed  Google Scholar 

  29. Yamamoto K et al (2016) Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer 20:913–918

    Article  PubMed  Google Scholar 

  30. Burger M, Mulders P, Witjes W (2012) Use of neoadjuvant chemotherapy for muscle-invasive bladder cancer is low among major European centres: results of a feasibility questionnaire. Eur Urol 61(5):1070–1071

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, St. Josef Medical Centre, University of Regensburg, Landshuterstr. 65, 93053, Regensburg, Germany

    Roman Mayr, Marieke Reiffen, Leopold Siebertz, Bas W. G. van Rhijn, Maximilian Burger & Michael Gierth

  2. Department of Urology, Surgical Clinic Munich-Bogenhausen, Munich, Germany

    Hans-Martin Fritsche

  3. Centre of Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany

    Florian Zeman

  4. Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany

    Christoph Niessen

  5. Department of Urology, Central Hospital of Bolzano, Bolzano, Italy

    Armin Pycha

  6. Sigmund Freud University, Medical School of Vienna, Vienna, Austria

    Armin Pycha

  7. Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Bas W. G. van Rhijn

Authors
  1. Roman Mayr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Martin Fritsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florian Zeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marieke Reiffen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leopold Siebertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Niessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Armin Pycha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bas W. G. van Rhijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maximilian Burger
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Gierth
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RM: Project development, data collection, data analysis, manuscript writing. HF: Project development, data collection, manuscript writing. FZ: Data analysis, manuscript writing, editing. MR: Data collection. LS: Data collection. CN: Data collection, protocol development. AP: Project development, manuscript writing. BWGR: Manuscript writing, data analysis, editing. MB: Supervision, manuscript writing. MG: Data collection, manuscript writing, editing.

Corresponding author

Correspondence to Roman Mayr.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mayr, R., Fritsche, HM., Zeman, F. et al. Sarcopenia predicts 90-day mortality and postoperative complications after radical cystectomy for bladder cancer. World J Urol 36, 1201–1207 (2018). https://doi.org/10.1007/s00345-018-2259-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2259-x

Keywords

Search

Navigation