Impact of cachexia on oncologic outcomes of sarcopenic patients with upper tract urothelial carcinoma after radical nephroureterectomy

• Published in: PloS one 2021-04, Vol.16 (4), p.e0250033-e0250033
• Main Authors: Chen, Hao-Wei, Chen, Yu-Chen, Yang, Li-Hwa, Shih, Ming-Chen Paul, Li, Ching-Chia, Chueh, Kuang-Shun, Wu, Wen-Jeng, Juan, Yung-Shun
• Format: Article
• Language: English
• Subjects: Abdomen; Age; Biology and Life Sciences; Bladder cancer; Body mass index; Cachexia; Cancer; Cardiovascular disease; Care and treatment; Clinical medicine; Comorbidity; Confidence intervals; Editing; Federal regulation; Gastrointestinal cancer; Hospitals; Informed consent; Kidney cancer; Medical prognosis; Medical schools; Medicine; Medicine and Health Sciences; Metastases; Metastasis; Musculoskeletal system; Patients; Prognosis; Radiology; Research and Analysis Methods; Risk groups; Sarcopenia; Urinary tract; Urinary tract cancer; Urology; Urothelial carcinoma; Vertebra; Vertebrae
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250033

To investigate the prognostic significance of sarcopenic cachexia compared to sarcopenia without cachexia in the outcomes of upper urinary tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). Between 2011 and 2016, 163 patients with UTUC who received RNU at a tertiary medical center were included. Pre-operatively clinical data, history, and abdominal computer tomography scans were analyzed retrospectively. The diagnosis of sarcopenia was based on abdominal computed tomography data on the patient's skeletal muscles. Outcomes of relapse-free, cancer-specific, and overall survival were analyzed by multivariate Cox regression. After adjusting for age, sex, pre-operatively estimated glomerular filtration rate, body mass index, underlying diseases, tumor grade, and tumor stage, cachexia was a significant poor prognostic factor for relapse-free survival (hazard ratio [HR]: 18.5, 95% confidence interval [CI]: 2.87-118, p = 0.002) and cancer-specific survival (HR: 26.6, 95% CI: 4.04-175, p = 0.001). In contrast, sarcopenia without cachexia was not a significant predictor of cancer outcomes. To date, this is the first study to investigate the effect of cachexia among sarcopenic patients with UTUC treated with RNU. We identified the prognostic significance of cachexia on outcomes. Indeed, when UTUC is treated with RNU, we should evaluate not only sarcopenia status but also cachexia. The low survival rate among patients with UTUC complicated with cachexia deserves attention.