Sarcopenia as a prognostic biomarker of advanced urothelial carcinoma

PLoS One. 2015 Jan 22;10(1):e0115895. doi: 10.1371/journal.pone.0115895. eCollection 2015.

Abstract

Objectives: Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients.

Methods: This retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm(2)/m(2) for males with body mass index (BMI) <25 cm(2)/m(2), <53 cm(2)/m(2) for males with BMI ≥ 25 cm(2)/m(2), and <41 cm(2)/m(2) for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models.

Results: Sixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, P <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (P <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, P <0.001), along with higher C-reactive protein (CRP) (P = 0.001), upper urinary tract cancer (P = 0.007), higher lactate dehydrogenase (LDH) (P = 0.047), and higher alkaline phosphatase (ALP) (P = 0.048).

Conclusion: Sarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor
  • Cachexia* / diagnostic imaging
  • Cachexia* / etiology
  • Cachexia* / mortality
  • Disease-Free Survival*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Models, Biological*
  • Predictive Value of Tests
  • Retrospective Studies
  • Sarcopenia* / diagnostic imaging
  • Sarcopenia* / etiology
  • Sarcopenia* / mortality
  • Survival Rate
  • Tomography, X-Ray Computed
  • Urologic Neoplasms* / diagnostic imaging
  • Urologic Neoplasms* / mortality

Substances

  • Biomarkers, Tumor

Grants and funding

This research was supported by the Clinical Research Fund (grant number H260301002, URL: http://www.metro.tokyo.jp/) of the Tokyo Metropolitan Government (HF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.