Impact of Preoperative Sarcopenia on Survival and Perioperative Outcomes After Radical Cystectomy for Bladder Cancer.

Background

Sarcopenia, the loss of skeletal muscle mass and function, is an adverse prognostic factor in oncology. The computed tomography-derived skeletal muscle index (SMI) is a pragmatic surrogate of muscle mass, but contemporary data on its impact on survival and perioperative outcomes after radical cystectomy remain scarce. PATIENTS AND

Methods

This retrospective single-center cohort study included 320 patients undergoing radical cystectomy for urothelial bladder carcinoma (2018-2024). Radiographic sarcopenia was defined using the sex-specific SMI thresholds of Prado et al. (men: < 52.4 cm²/m²; women: < 38.5 cm²/m²). The primary endpoint was overall survival (OS). Secondary endpoints included major postoperative complications (Clavien-Dindo ≥ 3), ICU admission, and prolonged hospital stay (≥ 25 days). Multivariable Cox and logistic regression models were applied.

Results

Sarcopenia was present in 50% of patients. At a median follow-up of 33.5 months, sarcopenia was independently associated with worse OS (hazard ratio 1.52, 95% confidence interval [CI] 1.03-2.23, P = .035; median OS 34.2 vs. 64.7 months). The association was directionally consistent across sensitivity analyses but attenuated with alternative SMI cutoffs. Sarcopenia was not independently associated with major postoperative complications (odds ratio [OR] 1.59, 95% CI 0.87-2.95), intensive care unit (ICU) admission (OR 1.27, 95% CI 0.75-2.14), or prolonged hospitalization (OR 1.10, 95% CI 0.64-1.90).

Conclusions

Preoperative sarcopenia was independently associated with worse OS following radical cystectomy. Sarcopenia was not independently associated with postoperative morbidity or resource utilization, although these analyses may have been underpowered. Computed tomography-based body composition assessment provides prognostic information independent of established clinical parameters.