Decreased Skeletal Muscle Mass is Associated with an Increased Risk of Mortality Following Radical Nephrectomy for Localized Renal Cell Cancer

To evaluate the association between severe skeletal muscle deficiency or sarcopenia and disease progression, cancer-specific (CSM), and all-cause mortality (ACM) among patients with localized renal cell carcinoma (RCC) treated with radical nephrectomy (RN).

Baseline lumbar skeletal muscle index (SMI) of 387 patients treated with RN for nonmetastatic RCC between 2000 and 2010 was measured on preoperative computed tomography. Sarcopenia was classified according to sex-specific consensus definitions: Male: SMI.

In total, 180/387 (47%) patients were sarcopenic. Sarcopenic patients were older, more likely to be male (77% vs. 56%, p<0.001), have a smoking history (67% vs. 55%, p=0.02), and have nuclear grade ≥3 (67% vs. 60%, p=0.05), but were otherwise similar to nonsarcopenic patients. Median postoperative follow-up was 7.2 years. Sarcopenic patients had inferior 5-year CSS (79% vs. 85%, p=0.05) compared to non-sarcopenic patients as well as significantly worse 5-year OS (65% vs. 74%, p= 0.005). As a continuous variable, increasing SMI was linearly associated with a decreased risk of CSM and ACM. Moreover, on multivariable analysis, sarcopenia was associated with increased CSM (HR 1.70, p=0.047) and ACM (HR 1.48, p=0.039).

Sarcopenia is independently associated with CSM and ACM following RN for RCC. These findings underscore the importance of assessing SMI for risk stratification, patient counseling, and treatment planning.

The Journal of urology 2015 Aug 17 [Epub ahead of print]

Sarah P Psutka, Stephen A Boorjian, Michael R Moynagh, Grant D Schmit, Brian A Costello, R Houston Thompson, Suzanne B Stewart-Merrill, Christine M Lohse, John C Cheville, Bradley C Leibovich, Matthew K Tollefson

Department of Urology, Mayo Clinic, Rochester MN , Department of Urology, Mayo Clinic, Rochester MN , Department of Radiology, Mayo Clinic, Rochester MN , Department of Radiology, Mayo Clinic, Rochester MN , Division of Medical Oncology, Department of Medicine, Mayo Clinic, Rochester MN , Department of Urology, Mayo Clinic, Rochester MN , Department of Urology, Mayo Clinic, Rochester MN , Department of Health Sciences Research, Mayo Clinic, Rochester MN , Department of Pathology, Mayo Clinic, Rochester MN , Department of Urology, Mayo Clinic, Rochester MN , Department of Urology, Mayo Clinic, Rochester MN

PubMed

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