Changes in Lean Muscle Mass Associated with Neoadjuvant Platinum-Based Chemotherapy in Patients with Muscle Invasive Bladder Cancer

Kalen J. Rimar, Alexander P. Glaser, Shilajit D Kundu, Edward Matthew Schaeffer, Joshua J Meeks, Sarah Patricia Psutka

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Baseline sarcopenia or severe lean muscle deficiency is independently associated with increased mortality after cystectomy for muscle-invasive urothelial carcinoma of the bladder (MIUC). The impact of chemotherapy on muscle mass in MIUC patients remains undefined Objectives: To describe preoperative changes in body composition in MIUC patients receiving platinum-based neoadjuvant chemotherapy (NC). Methods: Patients with cT2-4 N0-1 M0 UC of the bladder who received NC were identified. Lumbar skeletal muscle index (SMI, cm2/m2), visceral adipose index (VAI, cm2/m2), and the subcutaneous and intramuscular adipose index (SAI, cm2/m2) were calculated using validated methodology (cross sectional area of skeletal muscle/height2 at L3) from measurement of soft tissue areas on pre-(pre-NC) and post-NC (post-NC) computed tomography. Patients were classified as sarcopenic according to consensus definitions: Male: SMI 55 cm2/m2, Female: SMI <38.5 cm2/m2. Pre-NC and post-NC median body mass index (BMI kg/m2), SMI, and adipose indices were compared. Results: The study cohort consisted of 26 patients, with a median age 70 years, including 7 females (27%). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (31%), gemcitabine/cisplatin (62%) and gemcitabine/carboplatin (3.8%) with a median of 3.5 (range 2-6) cycles. Median pre-and post-NC BMI were 27.1 kg/m2 and 27.2 kg/m2 (p = 0.36). Median pre-and post-NC SMI were 49.1 cm2/m2 and 44.5 (p < 0.001) respectively. Median percent change in SMI was-6.4% (range-30% to 10%). Pre-NC, 18 (69%) patients were sarcopenic vs. 21 (81%, p = 0.002) post-NC. Median time between initiation of chemotherapy and cystectomy was 110 days. Conclusions: We observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. Patients undergoing NC may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy.

Original languageEnglish (US)
Pages (from-to)411-418
Number of pages8
JournalBladder Cancer
Volume4
Issue number4
DOIs
StatePublished - Jan 1 2018

Fingerprint

Platinum
Urinary Bladder Neoplasms
Drug Therapy
Muscles
Cystectomy
gemcitabine
Urinary Bladder
Sarcopenia
Carcinoma
Cisplatin
Skeletal Muscle
Vinblastine
Carboplatin
Body Composition
Methotrexate
Doxorubicin

Keywords

  • Bladder cancer
  • cisplatin
  • muscle invasive bladder cancer
  • neoadjuvant chemotherapy
  • platinum
  • sarcopenia
  • skeletal muscle index
  • skeletal muscle mass

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{0880d0e3d7754860a8a07bb957115eb0,
title = "Changes in Lean Muscle Mass Associated with Neoadjuvant Platinum-Based Chemotherapy in Patients with Muscle Invasive Bladder Cancer",
abstract = "Background: Baseline sarcopenia or severe lean muscle deficiency is independently associated with increased mortality after cystectomy for muscle-invasive urothelial carcinoma of the bladder (MIUC). The impact of chemotherapy on muscle mass in MIUC patients remains undefined Objectives: To describe preoperative changes in body composition in MIUC patients receiving platinum-based neoadjuvant chemotherapy (NC). Methods: Patients with cT2-4 N0-1 M0 UC of the bladder who received NC were identified. Lumbar skeletal muscle index (SMI, cm2/m2), visceral adipose index (VAI, cm2/m2), and the subcutaneous and intramuscular adipose index (SAI, cm2/m2) were calculated using validated methodology (cross sectional area of skeletal muscle/height2 at L3) from measurement of soft tissue areas on pre-(pre-NC) and post-NC (post-NC) computed tomography. Patients were classified as sarcopenic according to consensus definitions: Male: SMI 55 cm2/m2, Female: SMI <38.5 cm2/m2. Pre-NC and post-NC median body mass index (BMI kg/m2), SMI, and adipose indices were compared. Results: The study cohort consisted of 26 patients, with a median age 70 years, including 7 females (27{\%}). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (31{\%}), gemcitabine/cisplatin (62{\%}) and gemcitabine/carboplatin (3.8{\%}) with a median of 3.5 (range 2-6) cycles. Median pre-and post-NC BMI were 27.1 kg/m2 and 27.2 kg/m2 (p = 0.36). Median pre-and post-NC SMI were 49.1 cm2/m2 and 44.5 (p < 0.001) respectively. Median percent change in SMI was-6.4{\%} (range-30{\%} to 10{\%}). Pre-NC, 18 (69{\%}) patients were sarcopenic vs. 21 (81{\%}, p = 0.002) post-NC. Median time between initiation of chemotherapy and cystectomy was 110 days. Conclusions: We observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. Patients undergoing NC may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy.",
keywords = "Bladder cancer, cisplatin, muscle invasive bladder cancer, neoadjuvant chemotherapy, platinum, sarcopenia, skeletal muscle index, skeletal muscle mass",
author = "Rimar, {Kalen J.} and Glaser, {Alexander P.} and Kundu, {Shilajit D} and Schaeffer, {Edward Matthew} and Meeks, {Joshua J} and Psutka, {Sarah Patricia}",
year = "2018",
month = "1",
day = "1",
doi = "10.3233/BLC-180188",
language = "English (US)",
volume = "4",
pages = "411--418",
journal = "Bladder Cancer",
issn = "2352-3727",
publisher = "IOS Press",
number = "4",

}

Changes in Lean Muscle Mass Associated with Neoadjuvant Platinum-Based Chemotherapy in Patients with Muscle Invasive Bladder Cancer. / Rimar, Kalen J.; Glaser, Alexander P.; Kundu, Shilajit D; Schaeffer, Edward Matthew; Meeks, Joshua J; Psutka, Sarah Patricia.

In: Bladder Cancer, Vol. 4, No. 4, 01.01.2018, p. 411-418.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Changes in Lean Muscle Mass Associated with Neoadjuvant Platinum-Based Chemotherapy in Patients with Muscle Invasive Bladder Cancer

AU - Rimar, Kalen J.

AU - Glaser, Alexander P.

AU - Kundu, Shilajit D

AU - Schaeffer, Edward Matthew

AU - Meeks, Joshua J

AU - Psutka, Sarah Patricia

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Baseline sarcopenia or severe lean muscle deficiency is independently associated with increased mortality after cystectomy for muscle-invasive urothelial carcinoma of the bladder (MIUC). The impact of chemotherapy on muscle mass in MIUC patients remains undefined Objectives: To describe preoperative changes in body composition in MIUC patients receiving platinum-based neoadjuvant chemotherapy (NC). Methods: Patients with cT2-4 N0-1 M0 UC of the bladder who received NC were identified. Lumbar skeletal muscle index (SMI, cm2/m2), visceral adipose index (VAI, cm2/m2), and the subcutaneous and intramuscular adipose index (SAI, cm2/m2) were calculated using validated methodology (cross sectional area of skeletal muscle/height2 at L3) from measurement of soft tissue areas on pre-(pre-NC) and post-NC (post-NC) computed tomography. Patients were classified as sarcopenic according to consensus definitions: Male: SMI 55 cm2/m2, Female: SMI <38.5 cm2/m2. Pre-NC and post-NC median body mass index (BMI kg/m2), SMI, and adipose indices were compared. Results: The study cohort consisted of 26 patients, with a median age 70 years, including 7 females (27%). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (31%), gemcitabine/cisplatin (62%) and gemcitabine/carboplatin (3.8%) with a median of 3.5 (range 2-6) cycles. Median pre-and post-NC BMI were 27.1 kg/m2 and 27.2 kg/m2 (p = 0.36). Median pre-and post-NC SMI were 49.1 cm2/m2 and 44.5 (p < 0.001) respectively. Median percent change in SMI was-6.4% (range-30% to 10%). Pre-NC, 18 (69%) patients were sarcopenic vs. 21 (81%, p = 0.002) post-NC. Median time between initiation of chemotherapy and cystectomy was 110 days. Conclusions: We observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. Patients undergoing NC may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy.

AB - Background: Baseline sarcopenia or severe lean muscle deficiency is independently associated with increased mortality after cystectomy for muscle-invasive urothelial carcinoma of the bladder (MIUC). The impact of chemotherapy on muscle mass in MIUC patients remains undefined Objectives: To describe preoperative changes in body composition in MIUC patients receiving platinum-based neoadjuvant chemotherapy (NC). Methods: Patients with cT2-4 N0-1 M0 UC of the bladder who received NC were identified. Lumbar skeletal muscle index (SMI, cm2/m2), visceral adipose index (VAI, cm2/m2), and the subcutaneous and intramuscular adipose index (SAI, cm2/m2) were calculated using validated methodology (cross sectional area of skeletal muscle/height2 at L3) from measurement of soft tissue areas on pre-(pre-NC) and post-NC (post-NC) computed tomography. Patients were classified as sarcopenic according to consensus definitions: Male: SMI 55 cm2/m2, Female: SMI <38.5 cm2/m2. Pre-NC and post-NC median body mass index (BMI kg/m2), SMI, and adipose indices were compared. Results: The study cohort consisted of 26 patients, with a median age 70 years, including 7 females (27%). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (31%), gemcitabine/cisplatin (62%) and gemcitabine/carboplatin (3.8%) with a median of 3.5 (range 2-6) cycles. Median pre-and post-NC BMI were 27.1 kg/m2 and 27.2 kg/m2 (p = 0.36). Median pre-and post-NC SMI were 49.1 cm2/m2 and 44.5 (p < 0.001) respectively. Median percent change in SMI was-6.4% (range-30% to 10%). Pre-NC, 18 (69%) patients were sarcopenic vs. 21 (81%, p = 0.002) post-NC. Median time between initiation of chemotherapy and cystectomy was 110 days. Conclusions: We observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. Patients undergoing NC may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy.

KW - Bladder cancer

KW - cisplatin

KW - muscle invasive bladder cancer

KW - neoadjuvant chemotherapy

KW - platinum

KW - sarcopenia

KW - skeletal muscle index

KW - skeletal muscle mass

UR - http://www.scopus.com/inward/record.url?scp=85056356718&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056356718&partnerID=8YFLogxK

U2 - 10.3233/BLC-180188

DO - 10.3233/BLC-180188

M3 - Article

VL - 4

SP - 411

EP - 418

JO - Bladder Cancer

JF - Bladder Cancer

SN - 2352-3727

IS - 4

ER -