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Impact of Preoperative CT-Diagnosed Sarcopenic Obesity on Outcomes After Radical Cystectomy for Bladder Cancer
by
, , , , , , , and
Alberto Artiles Medina
1,*
,
Mariam Bajawi Carretero
2,
Enrique López Pérez
1,
Sara Garach Fernández
1,
David López Curtis
1,
Leyre Elías Pascual
3,
José Daniel Subiela
1,
Javier Soto Pérez-Olivares
4,
Catalina Nieto Góngora
4,
Fernando González Tello
5,
Irene de la Parra Sánchez
1,
César Mínguez Ojeda
1,
Victoria Gómez Dos Santos
1 and
Francisco Javier Burgos Revilla
1 1
Urology Department, Ramón y Cajal University Hospital, University of Alcalá, 28034 Madrid, Spain
2
Department of General Surgery, University Hospital of Guadalajara, 19002 Guadalajara, Spain
3
Biomedical Engineering, Universidad Politécnica de Madrid (UPM), 28034 Madrid, Spain
4
Engineering & Innovation Unit, Radiology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
5
Radiology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(16), 2669; https://doi.org/10.3390/cancers17162669
Submission received: 19 June 2025
/
Revised: 3 August 2025
/
Accepted: 11 August 2025
/
Published: 15 August 2025
(This article belongs to the Special Issue Clinical Outcomes in Urologic Cancers)
Simple Summary
Sarcopenia has been widely investigated as a predictor of postoperative complications. More recently, increasing attention has been devoted to additional body composition parameters, such as sarcopenic obesity. This study contributes to the growing body of evidence supporting the role of body composition assessment in predicting outcomes after radical cystectomy. Our findings emphasize the clinical utility of preoperative computed tomography (CT)-based body composition assessment, particularly highlighting sarcopenic obesity as a significant predictor of 90-day postoperative complications. However, despite its value in identifying patients at higher risk for complications, CT body composition assessment did not demonstrate a significant impact on survival in this study.
Abstract
Objective: To evaluate the impact of body composition parameters, including specifically sarcopenic obesity (SO), on postoperative and oncological outcomes in patients undergoing radical cystectomy (RC) for bladder cancer, thereby addressing a paucity of data in this setting. Methods: A retrospective observational study was conducted in patients who underwent RC. Preoperative CT scans were analyzed using semi-automatic segmentation software to assess body composition parameters, with measurements of adipose and muscle tissue obtained at the level of the L3 vertebra. Results: A total of 249 patients were included, of whom 127 (52.5%) met the criteria for sarcopenia, 53 (21.3%) for obesity, and 14 (5.6%) for SO. Multivariate analysis identified previous abdominal surgery (OR 2.56, 95% CI 1.24–5.23, p = 0.011), total serum protein level (OR 0.57, 95% CI 0.36–0.88, p = 0.013), and SO (OR 7.01, 95% CI 1.06–37.05, p = 0.045) as independent predictors of 90-day postoperative complications. Patients with SO experienced significantly higher rates of abdominal wall complications (p = 0.03). However, in multivariate analyses, SO was not associated with overall survival (despite a p value of 0.04 at univariate analysis), cancer-specific survival, or progression-free survival. Conclusions: Preoperative CT-based assessment of body composition is a valuable tool in the surgical evaluation of patients undergoing RC. SO appears to be an independent predictor of short-term postoperative complications and should be considered when planning prehabilitation strategies.
Keywords:
body composition; sarcopenia; obesity; sarcopenic obesity; cystectomy; bladder cancer
