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Published on: February 12, 2017
Dynamic Loss of Psoas Muscle Volume During Induction Chemotherapy Predicts Survival in Patients with Advanced
Ryutaro Shimizu1, Shuichi Morizane1, Noriya Yamaguchi1
1Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan.
Background:
Sarcopenia is increasingly recognized as a prognostic factor in oncology; however, most studies have focused on static baseline muscle mass in heterogeneous populations. Whether dynamic skeletal muscle loss during systemic therapy carries independent prognostic value, particularly in clinically stable patients with controlled disease, remains unclear. We investigated the prognostic relevance of three-dimensional volumetric muscle assessment in advanced urothelial carcinoma (UC) patients who achieved disease control with first-line platinum-based chemotherapy and subsequently received maintenance therapy.
Methods:
This multicenter retrospective study included 82 patients with unresectable or metastatic UC across 10 institutions. Psoas muscle volume (PMV) was quantified using three-dimensional computed tomography (CT) reconstruction. The relative percentage change in PMV during induction chemotherapy (ΔPMV) was calculated as: (PMV at pre-maintenance - PMV at baseline)/PMV at baseline × 100. A predefined PMV loss ≥ 5% (defined as ΔPMV ≤ -5%) was considered clinically significant. Baseline cross-sectional muscle indices, including skeletal muscle index (SMI), total psoas index (TPI), and paraspinal muscle index (PMI), as well as inflammatory and nutritional markers, were evaluated. Overall survival (OS) was analyzed using multivariable Cox regression.
Results:
During a median follow-up of 19 months, 35 deaths occurred. Baseline cross-sectional muscle indices (SMI, TPI, and PMI) were not associated with OS. In contrast, patients with PMV loss ≥ 5% (ΔPMV ≤ -5%) had significantly shorter OS. In multivariable analysis adjusting for clinical, inflammatory, and nutritional factors, PMV loss ≥ 5% remained independently associated with worse OS (HR 2.14, 95% CI 1.02-4.50, p = 0.044). Dynamic volumetric muscle decline may reflect clinically meaningful physiologic vulnerability despite tumor control.
Conclusions:
Dynamic loss of PMV during systemic therapy is a strong independent prognostic marker in advanced UC patients with controlled disease, whereas static baseline muscle indices lack prognostic significance. These findings highlight the clinical importance of preserving skeletal muscle mass during systemic therapy and support further investigation of targeted nutritional or supportive interventions.
