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Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder

BACKGROUND: Although the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change,...

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Autores principales: Miyake, Makito, Morizawa, Yosuke, Hori, Shunta, Marugami, Nagaaki, Shimada, Keiji, Gotoh, Daisuke, Tatsumi, Yoshihiro, Nakai, Yasushi, Inoue, Takeshi, Anai, Satoshi, Torimoto, Kazumasa, Aoki, Katsuya, Tanaka, Nobumichi, Fujimoto, Kiyohide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374611/
https://www.ncbi.nlm.nih.gov/pubmed/28359307
http://dx.doi.org/10.1186/s12885-017-3231-7
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author Miyake, Makito
Morizawa, Yosuke
Hori, Shunta
Marugami, Nagaaki
Shimada, Keiji
Gotoh, Daisuke
Tatsumi, Yoshihiro
Nakai, Yasushi
Inoue, Takeshi
Anai, Satoshi
Torimoto, Kazumasa
Aoki, Katsuya
Tanaka, Nobumichi
Fujimoto, Kiyohide
author_facet Miyake, Makito
Morizawa, Yosuke
Hori, Shunta
Marugami, Nagaaki
Shimada, Keiji
Gotoh, Daisuke
Tatsumi, Yoshihiro
Nakai, Yasushi
Inoue, Takeshi
Anai, Satoshi
Torimoto, Kazumasa
Aoki, Katsuya
Tanaka, Nobumichi
Fujimoto, Kiyohide
author_sort Miyake, Makito
collection PubMed
description BACKGROUND: Although the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change, from baseline, in nutritional status and volume of abdominal skeletal muscle mass and adipose tissue after radical cystetomy. METHODS: A retrospective analysis of 89 patients with bladder cancer, who underwent curative radical cystectomy, was conducted to assess the time course of change, from baseline, in body composition and nutritional status at 1, 3, 6, 12, and 24 months, after surgery. Skeletal muscle mass and abdominal adipose tissue mass were quantified by unenhanced computed tomography images. Two different nutritional indices, the Prognostic Nutritional Index and the Controlling Nutritional Status score were calculated from laboratory blood tests. We evaluated the prognostic value of the rate of change in the body composition and nutritional status after radical cystectomy. RESULTS: The cross-sectional area at the level of the third lumbar vertebra of the psoas major muscle and nutritional indices showed a transient deterioration at 1 and 3 months after radical cystectomy, with a return to baseline values from 6 to 24 months. A ≤ −10% loss in the area of the psoas muscle was associated with a shorter overall survival, compared to those with a > −10 change [hazard ratio (HR) 2.2, P = 0.02]. Multivariate analyzes identified sarcopenia status at baseline (HR 2.2, P = 0.03) and a ≤ −10% loss in the psoas muscle (HR 2.4, P = 0.02) were identified as independent prognostic factors for overall survival. A subanalysis of patients without sarcopenia identified a worse survival outcome for patients with a ≤ −10% loss in the psoas muscle (HR 2.6, P = 0.03) and ≤ − 5 change in the Prognostic Nutritional Index (HR 3.6, P = 0.01). CONCLUSION: Further research is required to establish appropriate rehabilitation protocols and nutritional interventions after radical cystectomy for maintaining skeletal muscle mass and nutrition status which could counteract physical deterioration and improve outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-017-3231-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-53746112017-04-03 Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder Miyake, Makito Morizawa, Yosuke Hori, Shunta Marugami, Nagaaki Shimada, Keiji Gotoh, Daisuke Tatsumi, Yoshihiro Nakai, Yasushi Inoue, Takeshi Anai, Satoshi Torimoto, Kazumasa Aoki, Katsuya Tanaka, Nobumichi Fujimoto, Kiyohide BMC Cancer Research Article BACKGROUND: Although the significance of preoperative nutritional status has been investigated, there is no report regarding the relationship of their postoperative changes on outcomes in patients who underwent radical cystectomy for bladder cancer. Here, we report the clinical impact of the change, from baseline, in nutritional status and volume of abdominal skeletal muscle mass and adipose tissue after radical cystetomy. METHODS: A retrospective analysis of 89 patients with bladder cancer, who underwent curative radical cystectomy, was conducted to assess the time course of change, from baseline, in body composition and nutritional status at 1, 3, 6, 12, and 24 months, after surgery. Skeletal muscle mass and abdominal adipose tissue mass were quantified by unenhanced computed tomography images. Two different nutritional indices, the Prognostic Nutritional Index and the Controlling Nutritional Status score were calculated from laboratory blood tests. We evaluated the prognostic value of the rate of change in the body composition and nutritional status after radical cystectomy. RESULTS: The cross-sectional area at the level of the third lumbar vertebra of the psoas major muscle and nutritional indices showed a transient deterioration at 1 and 3 months after radical cystectomy, with a return to baseline values from 6 to 24 months. A ≤ −10% loss in the area of the psoas muscle was associated with a shorter overall survival, compared to those with a > −10 change [hazard ratio (HR) 2.2, P = 0.02]. Multivariate analyzes identified sarcopenia status at baseline (HR 2.2, P = 0.03) and a ≤ −10% loss in the psoas muscle (HR 2.4, P = 0.02) were identified as independent prognostic factors for overall survival. A subanalysis of patients without sarcopenia identified a worse survival outcome for patients with a ≤ −10% loss in the psoas muscle (HR 2.6, P = 0.03) and ≤ − 5 change in the Prognostic Nutritional Index (HR 3.6, P = 0.01). CONCLUSION: Further research is required to establish appropriate rehabilitation protocols and nutritional interventions after radical cystectomy for maintaining skeletal muscle mass and nutrition status which could counteract physical deterioration and improve outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-017-3231-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-03-31 /pmc/articles/PMC5374611/ /pubmed/28359307 http://dx.doi.org/10.1186/s12885-017-3231-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Miyake, Makito
Morizawa, Yosuke
Hori, Shunta
Marugami, Nagaaki
Shimada, Keiji
Gotoh, Daisuke
Tatsumi, Yoshihiro
Nakai, Yasushi
Inoue, Takeshi
Anai, Satoshi
Torimoto, Kazumasa
Aoki, Katsuya
Tanaka, Nobumichi
Fujimoto, Kiyohide
Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title_full Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title_fullStr Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title_full_unstemmed Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title_short Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
title_sort clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374611/
https://www.ncbi.nlm.nih.gov/pubmed/28359307
http://dx.doi.org/10.1186/s12885-017-3231-7
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