Objectives: Sarcopenia, decreased skeletal muscle mass (SMM), is an adverse prognostic factor in patients with advanced urothelial carcinoma (aUC). Given that SMM is variable depending on disease and patient conditions, changes in SMM over the course of treatments may be also prognostic. We investigated the prognostic role of posttherapeutic SMM recovery (PSR) in patients with aUC receiving first-line platinum-based chemotherapy.
Materials and methods: This retrospective study included 72 consecutive patients with aUC receiving first-line platinum-based chemotherapy. Skeletal muscle index (SMI) was measured on computed tomography images taken before the initiation of and immediately after 2 cycles of chemotherapy. ΔSMI was calculated as [(posttherapeutic SMI - pretherapeutic SMI)/pretherapeutic SMI] × 100, and PSR was defined as ΔSMI >0. Variables associated with progression-free survival (PFS) and overall survival (OS) were evaluated.
Results: During the follow-up (median, 18mo for survivors), 60 (83%) patients progressed (2-year PFS, 17%) and 55 (76%) died (2-year OS, 24%). ΔSMI was significantly associated with chemotherapy response (P = 0.012), and was an independent predictor for both PFS (hazard ratio [HR] = 0.94, P<0.001) and OS (HR = 0.93, P<0.001). A total of 15 (21%) patients with PSR demonstrated significantly longer PFS and OS than those without PSR (both P<0.001). On multivariate analysis, PSR was an independent favorable predictor for both PFS (HR = 0.24, P<0.001) and OS (HR = 0.21, P<0.001). Incorporation of PSR into the Bajorin's and Galsky's models improved their c-indices (0.611-0.650, and 0.690-0.708, respectively).
Conclusions: PSR is a novel prognostic factor in patients with aUC receiving first-line platinum-based chemotherapy.
Keywords: Advanced urothelial carcinoma; Chemotherapy; Prognosis; Sarcopenia; Skeletal muscle mass.
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