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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Cancer 1/2017

Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder

Zeitschrift:
BMC Cancer > Ausgabe 1/2017
Autoren:
Makito Miyake, Yosuke Morizawa, Shunta Hori, Nagaaki Marugami, Keiji Shimada, Daisuke Gotoh, Yoshihiro Tatsumi, Yasushi Nakai, Takeshi Inoue, Satoshi Anai, Kazumasa Torimoto, Katsuya Aoki, Nobumichi Tanaka, Kiyohide Fujimoto
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12885-017-3231-7) contains supplementary material, which is available to authorized users.
The original version of this article was revised: so the variables, Sex, Clinical T, Clinical N, Variant histology, Neoadjuvant chemotherapy, adjuvant chemotherapy, and Sarcopenia status, appear on the left hand side of table 3 in the PDF only.
An erratum to this article is available at http://​dx.​doi.​org/​10.​1186/​s12885-017-3325-2.

Abstract

Background

Although the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change, from baseline, in nutritional status and volume of abdominal skeletal muscle mass and adipose tissue after radical cystetomy.

Methods

A retrospective analysis of 89 patients with bladder cancer, who underwent curative radical cystectomy, was conducted to assess the time course of change, from baseline, in body composition and nutritional status at 1, 3, 6, 12, and 24 months, after surgery. Skeletal muscle mass and abdominal adipose tissue mass were quantified by unenhanced computed tomography images. Two different nutritional indices, the Prognostic Nutritional Index and the Controlling Nutritional Status score were calculated from laboratory blood tests. We evaluated the prognostic value of the rate of change in the body composition and nutritional status after radical cystectomy.

Results

The cross-sectional area at the level of the third lumbar vertebra of the psoas major muscle and nutritional indices showed a transient deterioration at 1 and 3 months after radical cystectomy, with a return to baseline values from 6 to 24 months. A ≤ −10% loss in the area of the psoas muscle was associated with a shorter overall survival, compared to those with a > −10 change [hazard ratio (HR) 2.2, P = 0.02]. Multivariate analyzes identified sarcopenia status at baseline (HR 2.2, P = 0.03) and a ≤ −10% loss in the psoas muscle (HR 2.4, P = 0.02) were identified as independent prognostic factors for overall survival. A subanalysis of patients without sarcopenia identified a worse survival outcome for patients with a ≤ −10% loss in the psoas muscle (HR 2.6, P = 0.03) and ≤ − 5 change in the Prognostic Nutritional Index (HR 3.6, P = 0.01).

Conclusion

Further research is required to establish appropriate rehabilitation protocols and nutritional interventions after radical cystectomy for maintaining skeletal muscle mass and nutrition status which could counteract physical deterioration and improve outcomes.
Zusatzmaterial
Additional file 1: Table S1. Body composition index and nutrition index before radical cystectomy in 89 patients undergoing radical cystectomy. (DOCX 40 kb)
12885_2017_3231_MOESM1_ESM.docx
Additional file 2: Figure S1. Time course of change in the body composition and nutritional indices after radical cystectomy. For the body composition indices, the time course of change in absolute values is plotted. Data are expressed as means and standard deviations. Scores at each time point (1, 3, 6, 12, and 24 months after radical cystectomy) were compared to baseline (BL) scores using the Wilcoxon signed-rank test: *, P < 0.05; **, P < 0.01; and ***, P < 0.001. (TIFF 4267 kb)
12885_2017_3231_MOESM2_ESM.tif
Additional file 3: Figure S2. Comparison of changes after radical cystectomy between adjuvant chemotherapy-treated group and non-treated group.Time-course changes in cross-section area of the psoas major muscle at the level of L3 (a), abdominal skeletal muscle area at the level of L3 (b), the PNI (c) and, the CONUT score (d). Data of adjuvant chemotherapy-treated group (red) and non-treated group (blue) are plotted by means ± SD. Scores of two groups compared in each time point by the Mann-Whitney U-test. ns, not significant. (TIFF 7216 kb)
12885_2017_3231_MOESM3_ESM.tif
Additional file 4: Figure S3. Comparison of changes after radical cystectomy between neoadjuvant chemotherapy-treated group and non-treated group. Time-course changes in cross-section area of the psoas major muscle at the level of L3 (a), abdominal skeletal muscle area at the level of L3 (b), the PNI (c) and, the CONUT score (d). Data of neoadjuvant chemotherapy-treated group (red) and non-treated group (blue) are plotted by means ± SD. Scores of two groups compared in each time point by the Mann-Whitney U-test. ns, not significant. (TIFF 7424 kb)
12885_2017_3231_MOESM4_ESM.tif
Additional file 5: Figure S4. Kaplan-Meier curves for disease-specific survival and overall survival. Kaplan-Meier curves for disease-specific survival (DSS) and overall survival (OS) were compared for the postoperative change in the PNI (a), CONUT score (b), and psoas muscle mass (c). The cutoff values for postoperative change after RC was set based on median values as follows: −10%, −5 points and 2 points, respectively. The following separate analyzes were performed: all patients (left panels), patients without sarcopenia (middle panels), and patients with sarcopenia (right panels). Survival curves are compared using the log rank test. (TIFF 13821 kb)
12885_2017_3231_MOESM5_ESM.tif
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