Sarcopenia, the loss of skeletal muscle mass and function, is a condition commonly associated with aging and various chronic diseases. A recent study aimed to delve into the implications of sarcopenia in patients with muscle-invasive bladder cancer who were treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Published in “Clinical Genitourinary Cancer” in 2020, researchers from the esteemed Mayo Clinic sought to understand the correlation between sarcopenia and pathologic response, as well as survival outcomes.
To further unpack the findings of this study and its implications, let’s take an in-depth look at the methodology, results, and the potential consequences for the medical community and patients with muscle-invasive bladder cancer (MIBC).
Methodology
Lyon Timothy D., Frank Igor, and colleagues identified a cohort of 183 MIBC patients from the Mayo Clinic’s cystectomy registry from 2000 to 2016. These patients had been treated with cisplatin-based NAC. The researchers employed a validated body composition assessment tool, BodyCompSlicer, to analyze computed tomography (CT) images taken before and after NAC treatment.
Sarcopenia was defined based on the skeletal muscle index (SMI), referencing sex-specific international consensus values. The team used multivariable logistic and Cox proportional hazard regression models to explore associations between sarcopenia, clinical features, pathologic downstaging (<ypT2), major complications (Clavien III-V), and cancer-specific mortality (CSM).
Results
Over a median follow-up period of 3.0 years, it was observed that SMI declined by a median of 8.4% during NAC treatment. However, pretreatment sarcopenia was not notably linked with achieving downstaging to <ypT2 disease. More strikingly, the study found that only post-NAC sarcopenia was independently associated with an increased risk of CSM, with a hazard ratio of 1.90.
Following NAC and prior to RC, the presence of sarcopenia appeared to be a significant prognostic factor. The degree of muscle mass loss or the pretreatment SMI had no considerable associations with downstaging after NAC and RC. This led to the conclusion that sarcopenia’s value as a risk stratification tool for selecting patients for NAC or monitoring response to treatment is not supported by the data.
Implications and Interpretations
This study’s findings suggest that while muscle loss is common during chemotherapy treatment for bladder cancer, it doesn’t disadvantage the patient’s chance of responding to the treatment in terms of tumor downstaging. However, the muscle loss that persists after the chemotherapy and before undergoing RC surgery is a different matter, as it seems to worsen the patient’s prognosis regarding survival after cancer.
References
1. Lyon, T. D., Frank, I., Takahashi, N., Boorjian, S. A., Moynagh, M. R., Shah, P. H., … & Tollefson, M. K. (2020). Sarcopenia and Response to Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer. Clinical Genitourinary Cancer, 17(3), 216-222.e5.
DOI: 10.1016/j.clgc.2019.03.007
2. Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., … & Zamboni, M. (2010). Sarcopenia: European consensus on definition and diagnosis. Age and ageing, 39(4), 412-423.
DOI: 10.1093/ageing/afq034
3. Prado, C. M., Lieffers, J. R., McCargar, L. J., Reiman, T., Sawyer, M. B., Martin, L., & Baracos, V. E. (2008). Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. The Lancet Oncology, 9(7), 629-635.
DOI: 10.1016/S1470-2045(08)70153-0
4. Fearon, K., Strasser, F., Anker, S. D., Bosaeus, I., Bruera, E., Fainsinger, R. L., … & Tisdale, M. J. (2011). Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology, 12(5), 489-495.
DOI: 10.1016/S1470-2045(10)70218-7
5. Psutka, S. P., Carrasco, A., Schmit, G. D., Moynagh, M. R., Boorjian, S. A., Frank, I., … & Thapa, P. (2014). Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality. Cancer, 120(18), 2910-2918.
DOI: 10.1002/cncr.28793
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Conclusion
The study from the Mayo Clinic provides valuable insights into the role of muscle condition in patients undergoing treatment for muscle-invasive bladder cancer. While sarcopenia does not seem to affect the immediate response to chemotherapy, it’s clear that the patient’s muscle condition post-chemotherapy could have significant implications for their survival.
These findings underscore the importance of a holistic approach to patient health during cancer treatment—not just focusing on the tumor response but also considering the patient’s overall physical condition and the potential for interventions aimed at muscle preservation. As the medical community continues to develop better treatment protocols, the information gathered from this study could prove vital in improving the quality of life and outcomes for patients with muscle-invasive bladder cancer.