title: Mortality after radical cystectomy: impact of obesity versus adiposity after adjusting for skeletal muscle wasting.
abstract: OBJECTIVE
  We assess the impact of obesity, as measured conventionally by body mass index vs excess adiposity as measured by fat mass index, on mortality after radical cystectomy for bladder cancer, adjusting for the presence of skeletal muscle wasting.
  
  
  METHODS
  This retrospective cohort study included 262 patients treated with radical cystectomy for bladder cancer between 2000 and 2008 at the Mayo Clinic. Lumbar skeletal muscle and adipose compartment areas were measured on preoperative imaging. Overall survival was compared according to gender specific consensus fat mass index and skeletal muscle index thresholds as well as conventional body mass index based criteria. Predictors of all cause mortality were assessed by multivariable modeling.
  
  
  RESULTS
  Increasing body mass index correlated with improved overall survival (p=0.03) while fat mass index based obesity did not (p=0.08). After stratification by sarcopenia, no obesity related 5-year overall survival benefit was observed (68% vs 51.4%, p=0.2 obese vs normal and 40% vs 37.4%, p=0.7 sarcopenia vs sarcopenic/obese). On multivariable analysis class I obesity according to body mass index (HR 0.79, p=0.33) or fat mass index criteria (HR 0.85, p=0.45) was not independently associated with all cause mortality after adjusting for sarcopenia (HR 1.7, p=0.01) as well as age, performance status, pTN stage and smoking status. However, in patients with normal lean muscle mass each 1 kg/m(2) increase in weight or adipose mass was associated with a 7% to 14% decrease in all cause mortality.
  
  
  CONCLUSIONS
  After adjusting for lean muscle wasting, neither measurements of obesity nor adiposity were significantly associated with all cause mortality in patients treated with radical cystectomy, although subanalyses suggest a potential benefit among those with normal lean muscle mass.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Psutka
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Moynagh
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Grant D
authors.initials: GD
authors.lastname: Schmit
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Stewart
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Tarrell
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Prabin
authors.initials: P
authors.lastname: Thapa
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: tollefson.matthew@mayo.edu.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
mesh_terms: D050154:Adiposity; D015992:Body Mass Index; D015331:Cohort Studies; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal; D009765:Obesity / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D055948:Sarcopenia / Q000150:complications / Q000401:mortality*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*
keywords: body mass index; cystectomy; mortality; obesity; sarcopenia