title: Does Sarcopenia Impact Complications and Overall Survival in Patients Undergoing Radical Nephrectomy for Stage III and IV Kidney Cancer?
abstract: OBJECTIVE
  To investigate the association of sarcopenia (muscle mass wasting) with complications and survival in patients undergoing radical nephrectomy for advanced kidney cancer.
  
  
  METHODS
  We identified 137 patients with stage III and IV kidney cancer who underwent radical nephrectomy between 2008 and 2012. Preoperative cross-sectional imaging was used to measure total psoas area (TPA) at the level of L3 and controlled for height (m(2)). Sarcopenia was identified as TPA in the lowest gender-specific quartile. Patient characteristics and postoperative complications were compared between sarcopenic and nonsarcopenic patients. Kaplan-Meier survival curve estimates were generated for overall and gender-specific survival.
  
  
  RESULTS
  Preoperative cross-sectional imaging was available for 128 patients (93%, 85 men and 43 women). Mean TPA for men was 5.49 cm(2)/m(2) versus 4.27 cm(2)/m(2) for women (P < 0.05). Sarcopenia was associated with risk of Clavien grade III or higher complication (P = 0.03) and node-positive disease (P = 0.01). Median follow-up was 48.3 months. Kaplan-Meier estimates of overall and gender-specific survival were similar between sarcopenic and nonsarcopenic patients.
  
  
  CONCLUSIONS
  Sarcopenia appears to be associated with risk of major complication after radical nephrectomy for advanced kidney cancer. It was not related to overall survival, however. This preoperative imaging tool may be helpful in preoperative counseling and preparation.
authors.affiliation: Department of Urology, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Peyton
authors.affiliation: Department of Urology, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Heavner
authors.affiliation: Department of Urology, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: James T
authors.initials: JT
authors.lastname: Rague
authors.affiliation: Department of Urology, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Department of Urology, Wake Forest University School of Medicine , Winston Salem, North Carolina.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D016658:Psoas Muscles / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015996:Survival Rate