ACS 2019: Does Sarcopenia Predict Poor Outcomes Following Radical Cystectomy? A Contemporary Analysis and Evaluation of Commonly Used Criteria

San Francisco, California (UroToday.com) Nicholas B. Drury discussed how inconsistent cutoff values to define sarcopenia have been utilized throughout the literature. Their aim was to evaluate sarcopenia as a predictor of perioperative outcomes and survival following radical cystectomy with urinary diversion (RCUD) using the international consensus definition, Martin criteria, and Mayr criteria, as a standardized cutoff value could reduce bias across studies.  A retrospective analysis of RCUD patients from 2010-2017 at a single center institution was performed. Sarcopenia was defined according to the aforementioned criteria and assessed by measuring total psoas area (TPA) on preoperative computerized tomography (CT). The impact of sarcopenia on perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) was evaluated with univariate and multivariate regression models.

195 of 258 RCUD patients had available CT scans within 90 days of surgery. The median TPA scores among men and women were 578.0 and 459.6 mm2/mm2, respectively. The overall incidence of sarcopenia according to the international consensus, Martin criteria, and Mayr criteria was 36.4% (71/195), 24.1% (47/195), and 31.3% (61/195), respectively. Regardless of definition, significant differences were not observed in length of stay, high grade complications, readmissions, and discharge destination (all P > .05). Furthermore, sarcopenia was not significantly associated with CSS or OS. The 5-year CSS and OS were 46.3% and 66.2%, respectively.

In summary, irrespective of definition, they were unable to externally validate sarcopenia as a predictor of poor outcomes in our contemporary cohort. Future studies will evaluate the impact of our evolving perioperative care pathway on oncological outcomes, including its ability to mitigate sarcopenic effects.

Presented by: Nicholas B. Drury, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons Clinical Congress October 27-31, 2019  - San Francisco, CA