Sarcopenia may increase cisplatin toxicity in bladder cancer patients with borderline renal function

To assess whether the effect of sarcopenia on neoadjuvant chemotherapy (NAC) toxicity is modified by borderline renal function (estimated glomerular filtration rate [eGFR] 40-65 mL/min) and whether sarcopenia and borderline renal function are independently associated with NAC toxicity risk.

All patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) between 2010 and 2022, with available cross-sectional imaging prior to NAC initiation, were included. Skeletal mass was measured from axial computed tomography images obtained at the level of the L3 vertebral body, using Aquarius Intuition software. Sarcopenia was assigned based on consensus definitions of skeletal mass index. NAC toxicity was graded according to Common Terminology Criteria for Adverse Events version 5.0. Binary logistic regression was used to identify the predictors of NAC-associated renal toxicity.

A total of 216 patients were included. Most patients had sarcopenia (83%) and received gemcitabine/cisplatin NAC (76%). In an unadjusted model, sarcopenia was associated with a significant risk of renal-associated NAC toxicity (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.65-14.44; P = 0.004). In an effect modification model evaluating the interaction between sarcopenia and renal function, the OR for renal toxicity with sarcopenia among patients with eGFR 40-65 mL/min was 8.46 (95% CI 1.06-67.72) vs 3.11 (95% CI 0.81-11.88) among patients with normal renal function (P = 0.43).

Among MIBC patients who received NAC, sarcopenia was associated with higher odds of NAC-associated renal toxicity and may increase risk of renal toxicity among patients with borderline renal function.