肌少症可預測經尿道膀胱腫瘤切除術後接受卡介苗膀胱灌注的非肌肉侵犯型膀胱癌患者的腫瘤學結果

簡佑軒¹、黃亮鋼¹、林宇旌²、莊正鏗¹、馮思中¹、吳俊德¹、張英勛³、虞凱傑¹、林柏宏¹、甘弘成¹、曲元正¹、洪偉康⁴、謝明里¹、邵翊紘¹

¹林口長庚紀念醫院 外科部 泌尿外科；²基隆長庚紀念醫院 影像診療部；³新北市立土城醫院 泌尿外科；⁴長庚大學 醫學系

Sarcopenia can predict oncological outcome in non-muscle invasive bladder cancer patients who receive intravesical instillation with Bacillus Calmette-Guerin after transurethral resection of bladder tumor

Yu-Hsuan Chien¹, Liang-Kang Huang¹, Yu-Ching Ling², Cheng-Keng Chuang¹, See-Tong Pang¹, Wu-Chun Te¹, Ying-Hsu Chang³, Kai-Jie Yu¹, Po-Hung Lin¹, Hung-Cheng Kan¹, Yuan-Cheng Chu¹, Wei-Kang Hung⁴, Ming-Li Hsieh¹, and I-Hung Shao¹*

¹Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, ²Department of Medical Imaging and Intervention, Keelung Chang Gung Memorial Hospital, ³Department of Urology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, ⁴College of Medicine, Chang Gung University

Purpose:
Bladder cancer (BC) is the 10^th most common cancer worldwide and obesity is an independent risk factor for BC. Based on body mass index (BMI) and body composition, body status can be further categorized as sarcopenia or obesity, which has been demonstrated to have a marked impact on the outcome of BC. This study aimed to assess the impact of sarcopenia on the oncological prognosis of patients with non-muscle invasive bladder cancer (NMIBC).

Materials and Methods:

Patients with NMIBC who had received Transurethral resection of bladder tumor (TURBT) with adjuvant intravesical instillation (IVI) with Bacillus Calmette-Guerin (BCG) from March 2005 to April 2021 were recruited. Body composition parameters were evaluated according to computed tomography (CT) L3 images, and then further categorized by sarcopenia and obesity. We defined sarcopenia patient according to the European Working Group on Sarcopenia in Older Adults as two standard deviations below the mean of the healthy young adult population. Oncological outcomes including recurrence-free survival (RFS), progression-free survival (PFS) and overall survival (OS) after treatment were analyzed.

Results:

In total, 269 patients were enrolled in this study. All patients were diagnosed with NMIBC, and most were Ta or T1, accounting for 44.6% and 50.9%, respectively. 80 patients (29.7%) were sarcopenic at the time of initial diagnosis of NMIBC according to the CT images. In the Pearson’s correlation analysis test, we found that patients with sarcopenia were diagnosed at an older age (r = 0.263, p < 0.001). Sarcopenic patients endured significantly fewer BCG IVI than non-sarcopenic patients as well. Patients with sarcopenia had poorer RFS and OS using the Kaplan–Meier survival test (Figure 1). However, with regards to PFS, there was no significant difference (p = 0.390).

Conclusion:

This study is the first to demonstrate the impact of sarcopenia on the oncological prognosis of NMIBC treated with TURBT and BCG instillation. Non-sarcopenic patients can significantly endure more BCG IVI and may thus result in favourable oncological outcomes. Among patients with NMIBC, sarcopenic patients had worse OS and RFS than those without sarcopenia. Body composition is a helpful measurement to assess oncological outcomes of NMIBC patients. Further prospective research is required to validate the correlation between sarcopenia and oncological outcomes in patients with NMIBC.