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Sources of Funding: none

Introduction

The progression of cancer leads to metabolic disorders and malnutrition, which results in the loss of skeletal muscle mass (sarcopenia). Sarcopenia is an objective indicator of cancer cachexia, and has been previously reported as a predictor of hospitalization, postoperative complications as well as survival in cancer patients. _x000D_ Herein, we analyzed the changes in skeletal muscle mass during chemotherapy using computer tomography (CT) images, and verified whether sarcopenia is a predictive factor of overall survival (OS) or performance status (PS) deterioration._x000D_

Methods

We retrospectively reviewed patients with urothelial carcinoma (UC) who had received cisplatin-based chemotherapy as first line and GD (Gemicitabine plus Docetaxel) chemotherapy as second line treatment regimens between 2006 and 2015 in our hospital. Skeletal muscle area (SMA) at the third lumbar vertebrae was measured using CT images. Based on these data, we calculated skeletal muscle index (SMI = SMA/height2), and defined the changes in SMI for months between two points as δSMI (δSMI = SMI/duration). We verified the relationships among δSMI, OS and PS. Mann-Whitney U test, t-tests, Kaplan-Meier method and Log-rank test were used to analyze the data.

Results

This study included data from 55 UC patients. Due to lack of CT data, 20 patients were excluded at first line and 6 patients were excluded at second line. Median δL3 SMI during the first 2 cycles of first line chemotherapy was -1.66 (range, -5.92-1.62), and median δL3 SMI during the first 2 cycles of second line treatment was 0.042 (range, -1.10-7.42). The PS tended to deteriorate in patients when δL3 SMI was high during the first and second line treatments. By setting a cut-off value of δL3 SMI during the first 2 cycles of the first and second line regimen as -0.1 (first line) and -1 (second line), the Kaplan-Meier log rank analysis showed that patients in high δL3 SMI group (first line:< -0.1, second line< -1) had poorer OS when compared with those in the low δL3 SMI group (fist line:≥ -0.1, second line:≥ -1; P < 0.01; Figure)

Conclusions

It is possible to predict OS and PS deterioration in chemotherapy-treated UC patients by measuring δL3 SMI and setting proper cutoff of δL3 SMI. Thus, reduction of skeletal muscle mass may be considered as a useful predictor of prognosis in these patients.

Funding

none