Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer
Abstract
:1. Introduction
2. Metabolic Background of Cancer Cachexia and Sarcopenia
2.1. Adipose Tissue Depletion in Cancer Cachexia
2.2. Skeletal Muscle Depletion in Cancer Cachexia
3. Evaluation of Sarcopenia Using Computed Tomography (CT) Images
3.1. Measurement of Skeletal Muscle Mass Using CT Images
3.2. Skeletal Muscle Index (SMI)
3.3. Psoas Muscle Index (PMI)
3.4. Skeletal Muscle Density
4. Hybrid Nature of Sarcopenia as a Prognostic Biomarker
5. Systematic Literature Review
6. Prognostic Role of Sarcopenia in Bladder Cancer
6.1. Survival after a Radical Cystectomy
6.2. Survival in Inoperable Advanced Disease
7. Prognostic Role of Changes in Skeletal Muscle Mass in Bladder Cancer
8. Therapeutic Interventions for Sarcopenia
8.1. Nutritional Support
8.2. Medications
8.2.1. n-3 Fatty Acids
8.2.2. ActR2B Antagonist
8.2.3. Medications for Insulin Resistance
8.2.4. Inhibitors for Lipolysis and Fatty Acid Oxidation
8.2.5. Hormonal Replacement Therapy
8.3. Exercise
9. Future Perspectives
10. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study (Year) | Country | No. of Total Patients | No. of Sarcopenic Patients | Cancer Type | Therapeutic Interventions | Definition of Sarcopenia | Main Findings | Ref. |
---|---|---|---|---|---|---|---|---|
Smith et al. (2014) | United States | 200 | 77 (39%) | Bladder cancer | Radical cystectomy | TPA † < 653 cm2/m2 for males and <523 cm2/m2 for females | The Kaplan–Meier curves showed no significant association between OS and sarcopenia (p = 0.36). | [45] |
Psutka et al. (2014) | United States | 205 | 141 (69%) | Bladder cancer | Radical cystectomy | SMI < 55 cm2/m2 for males and <39 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 2.14 for CSS (p = 0.007) and 1.93 for OS (p = 0.004). | [46] |
Hirasawa et al. (2016) | Japan | 136 | 65 (48%) | Bladder cancer | Radical cystectomy | SMI < 43 cm2/m2 for males with BMI < 25 cm2/m2, <53 cm2/m2 for males with BMI ≥ 25 cm2/m2, and <41 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 2.3 for CSS (p = 0.015). | [47] |
Miyake et al. (2017) | Japan | 89 | 22 (25%) | Bladder cancer | Radical cystectomy | SMI < 43 cm2/m2 for males with BMI < 25 cm2/m2, <53 cm2/m2 for males with BMI ≥ 25 cm2/m2, and <41 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 2.2 for OS (p = 0.03). | [48] |
Saitoh-Maeda et al. (2018) | Japan | 63 (male only) | 141 (69%) | Bladder cancer | Radical cystectomy | PMI < 400 cm2/m2 | In male patients, non-sarcopenic patients had a significantly better OS than sarcopenic counterparts (2,889 vs. 2,009 days; p = 0.023). | [49] |
Mayr et al. (2018) | Germany | 500 | 189 (38%) | Bladder cancer | Radical cystectomy | SMI < 43 cm2/m2 for males with BMI < 25 cm2/m2, <53 cm2/m2 for males with BMI ≥ 25 cm2/m2, and <41 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 1.42 for CSS (p = 0.048) and 1.43 for OS (p = 0.01). | [50] |
Fukushima et al. (2015) | Japan | 88 | 67 (76%) | Advanced urothelial carcinoma | Miscellaneous | SMI < 43 cm2/m2 for males with BMI < 25 cm2/m2, <53 cm2/m2 for males with BMI ≥ 25 cm2/m2, and <41 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 3.36 for OS (p < 0.001). | [51] |
Taguchi et al. (2015) | Japan | 100 | Not reported | Metastatic urothelial carcinoma | Systemic chemotherapy | SMI < 55 cm2/m2 for males and <39 cm2/m2 for females | Sarcopenia was an independent poor prognostic factor with HR 2.07 for CSS (p = 0.045). | [52] |
Kasahara et al. (2017) | Japan | 27 | 14 (52%) | Advanced bladder cancer | Systemic chemotherapy | PMI < 2.49 cm2/m2 for males and <2.07 cm2/m2 for females | The OS of the non-sarcopenic group was significantly better than that of the sarcopenic group (561 vs. 223 days; p = 0.0150). | [53] |
Abe et al. (2018) | Japan | 87 | Not reported | Metastatic urothelial carcinoma | Systemic chemotherapy | SMI < 55 cm2/m2 for males and <39 cm2/m2 for females | Sarcopenia was not significantly associated with OS (p = 0.11). SMI stratified by BMI was an independent predictor for shorter OS (p = 0.026). | [54] |
Study (Year) | Country | No. of Total Patients | Cancer Type | Therapeutic Interventions | Evaluation of Skeletal Muscle Mass | Main Findings | Ref. |
---|---|---|---|---|---|---|---|
Miyake et al. (2017) | Japan | 89 | Bladder cancer | Radical cystectomy | Postoperative changes in psoas major muscle volume were calculated after a radical cystectomy. | A 10% loss in the volume of the psoas muscle was an independent poor prognostic factor with HR 2.4 for OS (p = 0.02). | [48] |
Zargar et al. (2017) | United States | 60 | Bladder cancer | NAC and a radical cystectomy | Changes in PMV were calculated from pre- and post-NAC CT images. | The proportion of PMV decline during NAC was not a predictor of OS after a radical cystectomy (p = 0.85). | [55] |
Fukushima et al. (2018) | Japan | 72 | Advanced urothelial carcinoma | Systemic chemotherapy | Changes in SMI were calculated from pretherapeutic and posttherapeutic CT images. | Post-therapeutic skeletal muscle mass recovery was an independent favorable prognostic factor with HR 0.24 for RFS (p < 0.001) and 0.21 for OS (p < 0.001). | [56] |
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Fukushima, H.; Takemura, K.; Suzuki, H.; Koga, F. Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer. Int. J. Mol. Sci. 2018, 19, 2999. https://doi.org/10.3390/ijms19102999
Fukushima H, Takemura K, Suzuki H, Koga F. Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer. International Journal of Molecular Sciences. 2018; 19(10):2999. https://doi.org/10.3390/ijms19102999
Chicago/Turabian StyleFukushima, Hiroshi, Kosuke Takemura, Hiroaki Suzuki, and Fumitaka Koga. 2018. "Impact of Sarcopenia as a Prognostic Biomarker of Bladder Cancer" International Journal of Molecular Sciences 19, no. 10: 2999. https://doi.org/10.3390/ijms19102999