title: Sarcopenia as a predictor of complications and survival following radical cystectomy.
abstract: OBJECTIVE
  Patients undergoing radical cystectomy face substantial but highly variable risks of major complications. Risk stratification may be enhanced by objective measures such as sarcopenia. Sarcopenia (loss of skeletal muscle mass) has emerged as a novel biomarker associated with adverse outcomes in many clinical contexts relevant to cystectomy. Based on these data we hypothesized that sarcopenia would be associated with increased 30-day major complications and mortality after radical cystectomy for bladder cancer.
  
  
  METHODS
  We performed a retrospective study of patients treated with radical cystectomy at our institution from 2008 to 2011. Sarcopenia was assessed by measuring cross-sectional area of the psoas muscle (total psoas area) on preoperative computerized tomography. Cutoff points were developed and evaluated using ROC curves to determine predictive ability in men and women for outcomes of major complications and survival.
  
  
  RESULTS
  Of 224 patients with bladder cancer 200 underwent preoperative computerized tomography within 1 month of surgery. Total psoas area was calculated with a mean score of 712 and 571 cm2/m2 in men and women, respectively. A clear association was noted between major complications and lower total psoas area in women using a cutoff of 523 cm2/m2 to define sarcopenia (AUC 0.70). Sarcopenia was not significantly associated with complications in men. There was a nonsignificant trend of sarcopenia with worse 2-year survival.
  
  
  CONCLUSIONS
  Sarcopenia in women was a predictor of major complications after radical cystectomy. Further research confirming sarcopenia as a useful predictor of complications would support the development of targeted interventions to mitigate the untoward effects of sarcopenia before cancer surgery.
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Hyeon
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Brian
authors.initials: B
authors.lastname: Boyd
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Matthews
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Geriatric Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Hyman
authors.initials: H
authors.lastname: Muss
authors.affiliation: Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
mesh_terms: D000367:Age Factors; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications; D016658:Psoas Muscles / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: cystectomy; postoperative complications; prognosis; sarcopenia; urinary bladder neoplasms