An in-depth analysis on the effects of body composition in patients receiving neoadjuvant chemotherapy for urothelial carcinoma
Landan MacDonald1, Myuran Thana2, Lori A. Wood2, Ricardo A. Rendon1, David Bell1, Jon Duplisea1, Ross Mason1.
1Department of Urology, Dalhousie University, Halifax, NS, Canada; 2Division of Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
Introduction: Neoadjuvant chemotherapy (NAC) is the standard of care for those patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).1 However, NAC can be associated with significant side effects and morbidity in some patients.2 Recent studies have shown that sarcopenia, obesity, and sarcopenic obesity are risk factors for increased morbidity and mortality after RC.3,4 NAC may contribute to these conditions. Our study examined the association between these conditions and morbidity in patients undergoing NAC.
Methods: We created a retrospective database of patients with non-metastatic MIBC receiving NAC prior to RC after receiving approval. Skeletal muscle index (SMI) and fat mass index (FMI) were calculated using computed tomography (CT) imaging at the L3 level. The change in SMI and FMI for a cohort of patients was calculated using CT scans done within three months prior to NAC and after the first two cycles, which is typically six weeks. The association between body composition (sarcopenia, obesity, and sarcopenic obesity) and preoperative adverse events was investigated using Chi-squared testing.
Results: A total of 73 patients were included in our study. There was a mean decrease in SMI of 2.2±3.2 cm2 m-2 (p<0.001). Adiposity and FMI were essentially unchanged by NAC, although there were outliers at either end of the distribution with significant changes. Overall, neither sarcopenia, obesity, or sarcopenic obesity were found to be associated with adverse events among patients receiving NAC in this univariable analysis. There was a total of 665 preoperative complications with grades 1–2 and 31 complications with grades 3–5.
Conclusions: Based on our retrospective cohort study, NAC did not seem to change obesity and FMI, but there was a significant decrease in SMI, indicating that NAC may worsen pre-existing sarcopenia. Sarcopenia, obesity, and sarcopenic obesity, however, may not significantly affect the rate of adverse events associated with NAC. As such, the presence of these factors may not help predict tolerance of NAC.
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[4] Psutka SP, Boorjian SA, Moynagh MR, et al: Mortality after radical cystectomy: impact of obesity versus adiposity after adjusting for skeletal muscle wasting. J. Urol. 2015; 193: 1507–1513.
