title: Sarcopenia as a Novel Preoperative Prognostic Predictor for Survival in Patients with Bladder Cancer Undergoing Radical Cystectomy.
abstract: To investigate the prognostic significance of sarcopenia on long-term outcomes in patients with bladder cancer after radical cystectomy (RC).
  
  
  
  We retrospectively reviewed 136 patients undergoing RC for urothelial carcinoma at our institution. Prognostic impact of the preoperative clinical, laboratory, and radiologic parameters were evaluated by Cox proportional hazard model analyses, and a nomogram was developed to predict cancer-specific survival (CSS) after RC.
  
  
  
  The mean follow-up was 46.7 months. Patients with sarcopenia had a significantly shorter CSS than those without sarcopenia. On univariate Cox analysis, clinical T stage, histology of transurethral resection of bladder tumor (TURBT) specimen, pretreatment hemoglobin, pretreatment neutrophil-to-lymphocyte ratio (NLR), pretreatment serum C-reactive protein level, pretreatment serum albumin level, presence of hydronephrosis, and presence of sarcopenia were associated with significantly worse CSS. On multivariate Cox stepwise analysis, sarcopenia (hazard rate [HR] = 2.3, p = 0.015), clinical T stage (cT4: HR = 5.3; p = 0.0096), presence of hydronephrosis (HR = 2.0; p = 0.033), histology of TURBT specimen (HR = 2.2, p = 0.044), and NLR (HR = 1.3; p = 0.0048) were significant independent predictors of an unfavorable prognosis Based on the results of the multivariate analysis, we developed a nomogram to predict 1-, 3-, and 5-year CSS after RC.
  
  
  
  Sarcopenia, clinical T stage, presence of hydronephrosis, histology of TURBT specimen, and NLR are novel preoperative prognostic factors even after adjustment for other known preoperative predictors in patients undergoing RC for bladder cancer.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan. wbqmd473@yahoo.co.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Hirasawa
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.|Department of Urology, Sanno Hospital, Tokyo, Japan.|Clinical Medicine Research Center, International University of Health and Welfare, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakashima
authors.affiliation: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yunaiyama
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakagami
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Horiguchi
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Namiki
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohori
authors.affiliation: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055948:Sarcopenia / Q000150:complications*; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery*