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Sources of Funding: None

Introduction

Sarcopenia, loss of skeletal muscle mass (SMM), develops as a consequence of cancer-mediated systemic inflammation and cachexia. We recently reported that sarcopenia is an adverse prognostic factor in advanced urothelial carcinoma (aUC) patients (PLoS One 2015). Given that SMM can vary depending on disease status and patient conditions during treatments, changes in SMM may predict prognosis of patients. Here, we investigated the prognostic role of post-therapeutic recovery of SMM (PRS) in aUC patients receiving 1st-line platinum-based chemotherapy (Cx).

Methods

This retrospective study included 72 consecutive aUC patients (inoperable cT4 and/or metastases to lymph nodes/distant organs) receiving 1st-line platinum-based Cx (64, cisplatin-based; 8, carboplatin-based) at a single cancer center from 2004 to 2016. Variables collected were age, sex, performance status, body mass index (BMI) before Cx, changes in BMI after Cx, primary site, lymph node/distant metastasis, hemoglobin, white blood cell count, creatinine, albumin, alkaline phosphatase, lactate dehydrogenase, corrected calcium, C-reactive protein, and response to Cx according to RECIST v1.1. Skeletal muscle index (SMI) was calculated by skeletal muscle areas at L3 normalized for height on CT images taken at ≤1M before the initiation of and immediately after 2 cycles of Cx. Patients were considered to show PRS when SMI after Cx surpassed that before Cx. We assessed variables associated with progression-free survival (PFS) and overall survival (OS) using the Cox proportional hazards model.

Results

Of the 72 patients, 15 (21%) showed PRS. During follow-up (median 13M), 60 developed progression (3Y PFS rate 13%) and 55 died (3Y OS rate 16%). PRS was associated with Cx response with a marginal significance (p = 0.069). On multivariate analysis, PRS was an independent predictor for PFS (HR 0.33, p = 0.002) along with distant metastasis (HR 1.84, p = 0.032) and good Cx response (HR 0.44, p = 0.002). PRS was also an independent predictor for OS (HR 0.21, p < 0.001). The 3Y PFS and OS rates for patients with and without PRS were 49% vs. 4% and 57% vs. 5%, respectively (both p < 0.001).

Conclusions

PRS predicts favorable prognosis in aUC patients receiving 1st-line platinum-based Cx.

Funding

None