Combination of Muscle Quantity and Quality Is Useful to Assess the Necessity of Surveillance after a 5-Year Cancer-Free Period in Patients Who Undergo Radical Cystectomy: A Multi-Institutional Retrospective Study

Naoki Fujita; Masaki Momota; Hirotaka Horiguchi; Itsuto Hamano; Jotaro Mikami; Shingo Hatakeyama; Hiroyuki Ito; Takahiro Yoneyama; Yasuhiro Hashimoto; Shoji Nishimura; Kazuaki Yoshikawa; Chikara Ohyama

doi:10.3390/cancers15051489

Combination of Muscle Quantity and Quality Is Useful to Assess the Necessity of Surveillance after a 5-Year Cancer-Free Period in Patients Who Undergo Radical Cystectomy: A Multi-Institutional Retrospective Study

Cancers (Basel). 2023 Feb 27;15(5):1489. doi: 10.3390/cancers15051489.

Authors

Naoki Fujita¹, Masaki Momota^{1

2}, Hirotaka Horiguchi^{1

3}, Itsuto Hamano^{1

4}, Jotaro Mikami^{1

2}, Shingo Hatakeyama⁵, Hiroyuki Ito⁶, Takahiro Yoneyama⁷, Yasuhiro Hashimoto¹, Shoji Nishimura³, Kazuaki Yoshikawa⁸, Chikara Ohyama^{1

7}

Affiliations

¹ Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
² Department of Urology, Mutsu General Hospital, 1-2-8 Kogawamachi, Mutsu 035-8601, Japan.
³ Department of Urology, Hakodate Municipal Hospital, 1-10-1 Minatomachi, Hakodate 041-8680, Japan.
⁴ Department of Urology, Towada City Central Hospital, 14-8 Nishijyunibancho, Towada 034-0093, Japan.
⁵ Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
⁶ Department of Urology, Aomori Rosai Hospital, 1 Minamigaoka Shiroganemachi, Hachinohe 031-8551, Japan.
⁷ Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
⁸ Department of Urology, Aomori City Hospital, 1-14-20 Katsuta, Aomori 030-0821, Japan.

Abstract

Background: Although continuous surveillance after a 5-year cancer-free period in patients with bladder cancer (BC) who undergo radical cystectomy (RC) is recommended, optimal candidates for continuous surveillance remain unclear. Sarcopenia is associated with unfavorable prognosis in various malignancies. We aimed to investigate the impact of low muscle quantity and quality (defined as severe sarcopenia) on prognosis after a 5-year cancer-free period in patients who underwent RC.

Methods: We conducted a multi-institutional retrospective study assessing 166 patients who underwent RC and had five years or more of follow-up periods after a 5-year cancer-free period. Muscle quantity and quality were evaluated using the psoas muscle index (PMI) and intramuscular adipose tissue content (IMAC) using computed tomography images five years after RC. Patients with lower PMI and higher IMAC values than the cut-off values were diagnosed with severe sarcopenia. Univariable analyses were performed to assess the impact of severe sarcopenia on recurrence, adjusting for the competing risk of death using the Fine-Gray competing risk regression model. Moreover, the impact of severe sarcopenia on non-cancer-specific survival was evaluated using univariable and multivariable analyses.

Results: The median age and follow-up period after the 5-year cancer-free period were 73 years and 94 months, respectively. Of 166 patients, 32 were diagnosed with severe sarcopenia. The 10-year RFS rate was 94.4%. In the Fine-Gray competing risk regression model, severe sarcopenia did not show a significant higher probability of recurrence, with an adjusted subdistribution hazard ratio of 0.525 (p = 0.540), whereas severe sarcopenia was significantly associated with non-cancer-specific survival (hazard ratio 1.909, p = 0.047). These results indicate that patients with severe sarcopenia might not need continuous surveillance after a 5-year cancer-free period, considering the high non-cancer-specific mortality.

Keywords: bladder cancer; intramuscular adipose tissue content; myosteatosis; psoas muscle index; radical cystectomy; sarcopenia; surveillance.

Abstract

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