SESAUA 2024: Skeletal Muscle Changes in Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy

( The 2024 Southeastern Section of the AUA (SESAUA) annual meeting featured a urothelial cancer session and a presentation by Dr. Edouard Nicaise discussing skeletal muscle changes in upper tract urothelial carcinoma following radical nephroureterectomy. Definitive local treatment for high-risk upper tract urothelial carcinoma includes radical nephroureterectomy. Importantly, baseline low muscle mass (ie. sarcopenia) is independently associated with overall survival in upper tract urothelial carcinoma patients following radical nephroureterectomy. At the 2024 SESAUA annual meeting, Dr. Nicaise and colleagues examined the relationship between preoperative (baseline) and postoperative changes in muscle quantity with overall survival following radical nephroureterectomy.

The nephrectomy database at Emory University was reviewed for patients with histologically confirmed upper tract urothelial carcinoma treated with radical nephroureterectomy (median follow-up: 49.2 months). Exclusion criteria were defined as baseline metastatic disease, unavailable cross-sectional imaging within 90 days preoperatively and 1 year postoperatively, and unknown follow-up. The axial images were segmented at the mid-L3 vertebral level using Slice-O-Matic software (Tomovision, version 5.0). Skeletal muscle index was calculated using combined skeletal muscle surface area normalized by height in meters squared. ANOVA for numerical and generalized chi-square tests for categorical variables was used to test for differences according to percent change in skeletal muscle index. The relationship between the percent change in skeletal muscle index and overall survival was determined using a univariable Kaplan-Meier curve and a multivariable Cox Hazards model.

From 2006-2022, 91 patients were stratified by a change in skeletal muscle index: 28 stable (30.8%; skeletal muscle index change <5% [0Δ]), 17 increased (18.7%; skeletal muscle index +5% increase [+Δ]), and 46 decreased (50.5%; skeletal muscle index -5% decrease [-Δ]). Median time between preoperative imaging to surgery was 39 days, while median time to postoperative imaging was 87 days. There were no significant baseline differences, including skeletal muscle index (45.5 [0Δ], 39.1 [+Δ], 46.3 [-Δ] cm2/m2; p = 0.057). Moreover, no differences were noted regarding pathologic staging or perioperative outcomes. The following table highlights the baseline and pathologic characteristics of this cohort:

Median overall survival was highest among patients with 0Δ skeletal muscle index (49.8 [0Δ] vs. 51.2 [+Δ] vs. 26.0 [-Δ] months; p=0.0009):


On multivariable analysis adjusting for obesity, sex, race, ECOG performance status, tumor size, skeletal muscle index, and pT-stage, 0Δ skeletal muscle index (HR 0.21, 95% CI 0.07-0.64; p = 0.006) and ECOG ≥1 (HR 3.59, 1.38-9.36; p = 0.009) were factors predictive of overall survival:


Dr. Nicaise concluded his presentation by discussing skeletal muscle changes in upper tract urothelial carcinoma following radical nephroureterectomy with the following conclusions:

  • Change in muscle mass following radical nephroureterectomy is independently associated with overall survival in upper tract urothelial carcinoma
  • Of note, lack of change demonstrated the greatest survival, even when adjusted for baseline muscle mass
  • Cohort expansion is planned to further characterize survival outcomes in upper tract urothelial carcinoma patients

To conclude, Dr. Nicaise highlighted the following clinical scenario:


Presented by: Edouard Nicaise, MD, Emory University School of Medicine, Atlanta, GA

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Austin, TX, Wed, Mar 20 – Sat, Mar 23, 2024.