title: Sarcopenia as a prognostic biomarker of advanced urothelial carcinoma.
abstract: OBJECTIVE
  Sarcopenia, a novel concept reflecting the degenerative loss of skeletal muscle mass, is an objective indicator of cancer cachexia. We investigated its role as a prognostic biomarker in advanced urothelial carcinoma (UC) patients.
  
  
  METHODS
  This retrospective study consisted of 88 UC patients with cT4 and/or metastases to lymph nodes/distant organs. Skeletal muscle index (SMI), an indicator of whole-body muscle mass, was measured from computed tomography (CT) images at the diagnosis. Sarcopenia was defined as SMIs of <43 cm(2)/m(2) for males with body mass index (BMI) <25 cm(2)/m(2), <53 cm(2)/m(2) for males with BMI ≥ 25 cm(2)/m(2), and <41 cm(2)/m(2) for females. Predictors of overall survival (OS) were examined using Cox proportional hazard models.
  
  
  RESULTS
  Sixty-seven patients (76%) died during the median follow-up of 13 months. The median OS rate was 13 months. Multivariate analysis revealed that SMI was a significant and independent predictor of shorter OS (hazard ratio (HR) 0.90, P <0.001). In the present cohort, 53 (60%) were diagnosed with sarcopenia. The median OS rates were 11 and 31 months for sarcopenic and non-sarcopenic patients, respectively (P <0.001). On multivariate analysis, sarcopenia was a significant and independent predictor of shorter OS (HR 3.36, P <0.001), along with higher C-reactive protein (CRP) (P = 0.001), upper urinary tract cancer (P = 0.007), higher lactate dehydrogenase (LDH) (P = 0.047), and higher alkaline phosphatase (ALP) (P = 0.048).
  
  
  CONCLUSIONS
  Sarcopenia, which is readily evaluated on routine CT scans, is a useful prognostic biomarker of advanced UC. Non-sarcopenic patients can expect long-term survival. Evaluating sarcopenia can be helpful for decision-making processes in the management of advanced UC patients.
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukushima
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Tobisu
authors.affiliation: Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D002100:Cachexia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality
chemical_list: D014408:Biomarkers, Tumor