Impact of Muscle Depletion on Prognosis in Patients Undergoing Radical Cystectomy

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Purpose To evaluate the prognostic impact of preoperative muscle depletion (including sarcopenia and myosteatosis) in patients with bladder cancer (BCa) after radical cystectomy (RC). Methods We retrospectively reviewed 185 patients undergoing RC for urothelial carcinoma. We used the computed tomography images at the L3 level of patients to get the skeletal muscle index (SMI) and skeletal muscle density (SMD). Sarcopenia is defined by the SMI while myosteatosis is defined by SMD. We used univariate Cox regression analysis to identify risk factors and included these risk factors in a multivariate Cox regression analysis to calculate the hazard ratio ( HR ) and 95% confidence interval ( 95% CI ). Results In the univariate Cox analysis, sarcopenia ( P < 0.001) and myosteatosis ( P = 0.017) were both associated with poorer overall survival (OS). Meanwhile, sarcopenia ( P < 0.001) and myosteatosis ( P = 0.019) were both associated with poorer progression-free survival (PFS). In the multivariate Cox analysis, sarcopenia was identified as an independent risk factor for both OS ( P = 0.018) and PFS ( P = 0.005), whereas myosteatosis was not an independent risk factor for OS ( P = 0.225) or PFS ( P = 0.104). Conclusions Preoperative muscle depletion (including sarcopenia and myosteatosis) significantly correlates with poor prognosis of patients undergoing RC. Sarcopenia is an in dependent risk factor for 5-year OS and PFS. Our nomogram models demonstrated good predictive accuracy. Preoperative identification of muscle depletion and tailored interventions (exercise and nutrition) may improve postoperative outcomes. Micro Abstract We evaluated the impact of muscle depletion (including sarcopenia and myosteatosis) on the prognosis of bladder cancer patients after radical cystectomy. We use univariate and multivariate Cox analyses to identify the risk factors and construct a model. Sarcopenia is as an independent risk factor for overall survival and progression-free survival, while myosteatosis was not. Recognizing and managing sarcopenia preoperatively may help improve patient outcomes.

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