Prognostic Value And Association Of Sarcopenia For Patients With Bladder Cancer Undergoing Transurethral Resection Of Bladder Tumor

Background:Bladder cancer incidence and mortality have increased gradually,which seriously affects people’s health and quality of life.Transurethral resection of bladder tumor(TURBT)has emerged as a first choice option for the diagnosis and treatment of non muscle invasive bladder cancer(NMIBC)and is also indicated for the treatment of partial muscle invasive bladder cancer(MIBC).Sarcopenia is an elderly syndrome associated with progressive reduction of skeletal muscle mass,muscle strength and / or physical function.Studies have found that sarcopenia is associated with poor prognosis of bladder cancer,liver cancer,melanoma,gastric cancer,esophageal cancer and other malignant tumors.Objective:The aim of this study is to investigate the prognostic value of preoperative sarcopenia in patients with bladder cancer after transurethral resection of bladder tumor.Method:We retrospectively reviewed patients with bladder cancer who were hospitalized in the Department of Urology and geriatrics of the First Affiliated Hospital of Nanchang University and underwent transurethral resection of bladder tumor from August 2014 to December 2015.According to the abdominal computed tomography(CT)images of patients with bladder cancer within 30 days before operation,the skeletal muscle area of the third lumbar spine was measured and the skeletal muscle index at the third lumbar vertebra(L3 SMI)was calculated.According to Martin’s diagnostic criteria,according to gender,BMI,L3 SMI were divided into sarcopenic and non sarcopenic groups.Patients were compared for age(age at the time of surgery),gender,weight,height,body mass index(BMI),history of diabetes mellitus,history of hypertension,lymphocyte count(TLC),total monocyte count(TMC),serum albumin(ALB),hemoglobin(HB),creatinine(creatinine,Cre),differences in LMR values,tumor size,tumor number,Clinical T stage of the tumor,histological grade of the tumor,type of Pathology,hydronephrosis,length of postoperative hospital stay,and total cost of hospital stay were evaluated.Cox proportional hazards models were used to analyze risk factors affecting 5-year overall survival in patients with bladder cancer who underwent transurethral resection of the bladder.Results:1.Compared with patients without sarcopenia,the age of patients with sarcopenia was significantly higher(p < 0.01),BMI and lymphocyte count were significantly lower(p < 0.05),and the proportion of multiple tumors was significantly higher(p< 0.05).2.There were no significant differences in hypertension,diabetes,smoking,hydronephrosis,pathological grade,tumor clinical T stage,tumor size,the second bladder tumor resection,length of postoperative hospital stay,total cost of hospitalization,creatinine,serum albumin,hemoglobin,LMR,monocyte count between sarcopenia,group and non sarcopenia group(p > 0.05).3.Compared with patients without sarcopenia,the 5-year overall survival of patients with sarcopenia was significantly decreased(p < 0.01).4.Multivariate Cox regression analysis showed that sarcopenia,tumor clinical T stage and LMR were independent risk factors for the prognosis of bladder cancer patients receiving TURBT(p < 0.05).Conclusions:1.The 5-year overall survival of bladder cancer patients with sarcopenia after TURBT was significantly reduced.2.Clinical T stage and LMR are independent risk factors for the prognosis of bladder cancer patients receiving TURBT.