An In-depth Analysis on the Effects of Body Composition in Patients Receiving Neoadjuvant Chemotherapy for Urothelial Cell Carcinoma

Overview

Journal Can Urol Assoc J

Specialty Urology

Date 2024 Feb 21

PMID 38381924

Authors

Landan MacDonald

Ricardo A Rendon

Myuran Thana

Lori Wood

Robyn Macfarlane

David Bell

Jon Duplisea

Ross Mason

Affiliations

Soon will be listed here.

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) is the standard of care for patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC); however, NAC can be associated with significant side effects and morbidity in some patients. NAC may contribute to sarcopenia, obesity, and the combination of the two. Our study examined the effects of NAC on body composition and the association between body composition and adverse events.

Methods: We created a retrospective database of patients with non-metastatic MIBC receiving NAC prior to RC. The change in skeletal muscle index (SMI) and fat mass index (FMI) was calculated using computed tomography (CT) scans done within three months prior to NAC and after the first two cycles. The association between body composition (sarcopenia, obesity, and sarcopenic obesity) and preoperative adverse events was investigated using a multivariable logistic regression. Changes in body composition were calculated using a paired Student's t-test.

Results: A total of 70 patients were included in our study. There was a mean decrease in SMI of 2.2±3.2 cm/m. Adiposity and FMI were unchanged by NAC. Sarcopenic obesity was found to be associated with adverse events among patients receiving NAC in the multivariable analysis. There was a total of 637 preoperative complications with grades 1-2 and 33 complications with grades 3-5.

Conclusions: Based on our retrospective cohort study, NAC did not affect obesity and FMI, but there was a significant decrease in SMI. Sarcopenic obesity was associated with increased severity of NAC adverse events. As such, the presence of this factor may help predict tolerance of NAC.

References

Gao J, Shi Y, Zhou D, Zhang Y, Tian D, Wu C . Sarcopenia as an independent predictor for venous thromboembolism events in bladder cancer patients undergoing radical cystectomy. Support Care Cancer. 2021; 30(2):1191-1198. DOI: 10.1007/s00520-021-06423-2. View

Fearon K, Strasser F, Anker S, Bosaeus I, Bruera E, Fainsinger R . Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011; 12(5):489-95. DOI: 10.1016/S1470-2045(10)70218-7. View

Jan A, Dolan D, Lombardi K, Gupta S . Tolerability of Gemcitabine Plus Cisplatin for Treatment of Urothelial Cancer in the Elderly Population. Clin Genitourin Cancer. 2015; 14(3):e257-63. DOI: 10.1016/j.clgc.2015.09.003. View

Psutka S, Boorjian S, Moynagh M, Schmit G, Frank I, Carrasco A . Mortality after radical cystectomy: impact of obesity versus adiposity after adjusting for skeletal muscle wasting. J Urol. 2014; 193(5):1507-13. PMC: 4556235. DOI: 10.1016/j.juro.2014.11.088. View

Santilli V, Bernetti A, Mangone M, Paoloni M . Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2015; 11(3):177-80. PMC: 4269139. View

Anandavadivelan P, Brismar T, Nilsson M, Johar A, Martin L . Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr. 2015; 35(3):724-30. DOI: 10.1016/j.clnu.2015.05.011. View

Mayr R, Fritsche H, Zeman F, Reiffen M, Siebertz L, Niessen C . Sarcopenia predicts 90-day mortality and postoperative complications after radical cystectomy for bladder cancer. World J Urol. 2018; 36(8):1201-1207. DOI: 10.1007/s00345-018-2259-x. View

Mari A, DAndrea D, Kimura S, Resch I, Shariat S, Klatte T . Sarcopenia as a Predictive Factor for Response to Upfront Cisplatin-Based Chemotherapy in Patients with Muscle-Invasive Urothelial Bladder Cancer. Urol Int. 2018; 101(2):197-200. DOI: 10.1159/000489013. View

Rizzoli R, Reginster J, Arnal J, Bautmans I, Beaudart C, Bischoff-Ferrari H . Quality of life in sarcopenia and frailty. Calcif Tissue Int. 2013; 93(2):101-20. PMC: 3747610. DOI: 10.1007/s00223-013-9758-y. View

10.

Kelly T, Wilson K, Heymsfield S . Dual energy X-Ray absorptiometry body composition reference values from NHANES. PLoS One. 2009; 4(9):e7038. PMC: 2737140. DOI: 10.1371/journal.pone.0007038. View

11.

Kurita Y, Kobayashi N, Tokuhisa M, Goto A, Kubota K, Endo I . Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology. 2018; 19(1):127-135. DOI: 10.1016/j.pan.2018.11.001. View

12.

Hansen T, Omland L, Von Heymann A, Johansen C, Clausen M, Suetta C . Development of Sarcopenia in Patients With Bladder Cancer: A Systematic Review. Semin Oncol Nurs. 2021; 37(1):151108. DOI: 10.1016/j.soncn.2020.151108. View

13.

Gao Q, Hu K, Gao J, Shang Y, Mei F, Zhao L . Prevalence and prognostic value of sarcopenic obesity in patients with cancer: A systematic review and meta-analysis. Nutrition. 2022; 101:111704. DOI: 10.1016/j.nut.2022.111704. View

14.

Lee L, Cheung W, Atkinson E, Krzyzanowska M . Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J Clin Oncol. 2010; 29(1):106-17. DOI: 10.1200/JCO.2010.31.3049. View

15.

Zargar H, Almassi N, Kovac E, Ercole C, Remer E, Rini B . Change in Psoas Muscle Volume as a Predictor of Outcomes in Patients Treated with Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer. Bladder Cancer. 2017; 3(1):57-63. PMC: 5271424. DOI: 10.3233/BLC-160080. View

16.

Yamashita S, Iguchi T, Koike H, Wakamiya T, Kikkawa K, Kohjimoto Y . Impact of preoperative sarcopenia and myosteatosis on prognosis after radical cystectomy in patients with bladder cancer. Int J Urol. 2021; 28(7):757-762. DOI: 10.1111/iju.14569. View

17.

Mourtzakis M, Prado C, Lieffers J, Reiman T, McCargar L, Baracos V . 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. 2008; 33(5):997-1006. DOI: 10.1139/H08-075. View

18.

Mayr R, Gierth M, Zeman F, Reiffen M, Seeger P, Wezel F . Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer. J Cachexia Sarcopenia Muscle. 2018; 9(3):505-513. PMC: 5989852. DOI: 10.1002/jcsm.12279. View

19.

Gortan Cappellari G, Brasacchio C, Laudisio D, Lubrano C, Pivari F, Barrea L . Sarcopenic obesity: What about in the cancer setting?. Nutrition. 2022; 98:111624. DOI: 10.1016/j.nut.2022.111624. View

20.

Carneiro I, Mazurak V, Prado C . Clinical Implications of Sarcopenic Obesity in Cancer. Curr Oncol Rep. 2016; 18(10):62. DOI: 10.1007/s11912-016-0546-5. View