Prevalence and prognostic impact of cancer cachexia in patients with bladder cancer: a multicenter retrospective...

Cancer cachexia is characterized by progressive skeletal muscle loss and systemic inflammation. Although sarcopenia is a known prognostic factor in bladder cancer, the prevalence and prognostic significance of cancer cachexia defined by standardized criteria remain unclear.

We retrospectively analyzed patients receiving first-line systemic chemotherapy for urothelial carcinoma at three institutions. Cancer cachexia was defined using the 2011 European Palliative Care Research Collaborative (EPCRC) criteria based on weight loss, body mass index, and CT-derived L3 skeletal muscle index. Patients were categorized by onset timing: no cachexia, baseline cachexia (pre-treatment), and acquired cachexia (developed during treatment). Survival outcomes and prognostic factors were analyzed using Kaplan-Meier methods, logistic regression, and Cox proportional hazards models.

Among 150 eligible patients, 45 (30.0%) had baseline cachexia, and 67 (44.7%) developed acquired cachexia during the observation period, resulting in a cumulative prevalence of 74.7%. Cachexia was significantly associated with advanced disease stage and sarcopenia. Overall survival (OS) significantly differed among the three groups (log-rank test, P = 0.005). The median OS was not reached in the no cachexia group, 836 days in the acquired cachexia group, and 742 days in the baseline cachexia group. Multivariable Cox analysis identified acquired cachexia, baseline cachexia and elevated C-reactive protein (CRP) (≥ 0.4 mg/dL) as independent predictors of poor OS.

Cancer cachexia is highly prevalent in patients with bladder cancer receiving first-line chemotherapy and is independently associated with reduced survival, regardless of onset timing. Early identification may improve risk stratification and guide supportive interventions.