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Master Thesis

Impact de la sarcopénie sur la fonction rénale au cours de la chimiothérapie néoadjuvante et sur les complications post cystectomie des patients pris en charge pour une tumeur de la vessie infiltrant le muscle vésical localisée

Abstract : Introduction & objectives : Several studies suggested that sarcopenia is associated with a higher rate of post cystectomy complications. The aim of our study was to assess sarcopenia variation during care and impact of sarcopenia status on post neoadjuvant chemotherapy (NAC) and postoperative complications in a cohort of patients treated with NAC and radical cystectomy (RC) for muscle invasive urothelial carcinoma of the bladder (UCB).
Materials & methods : This study received approval from an Institutional Review Board and ethics approval. Consecutive patients who underwent NAC and RC for cT2-T4 N0 M0 UCB at our institute between January, 2012 and December, 2017 were retrospectively identified. Using CT scan before NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers blinded to patient’s status. We defined severe sarcopenia as SMI <50 cm2/m2 for men and SMI <35 cm2/m2 for women. We evaluated post-NAC renal impairment, defined as a decrease in GFR (CKD-EPI) of 10 mL/min or more. We also assessed post-cystectomy complications using Clavien-Dindo classification.
Results : A total of 82 patients were included. Regarding SMI, 47 (57.3%) were classified as sarcopenic and 35 (42.7%) non sarcopenic. Except for BMI, the two sub-groups did not differ significantly. Among non-sarcopenic patients, 9 (19.1%) became sarcopenic after NAC (p=0.01). In multivariate analysis, sarcopenia was an independent significant predictor of post NAC renal impairment (OR 3.01; 95% CI 1.13–8.05; p=0.02). There was a trend to development of post NAC 3B stage kidney failure (GFR < 45 mL/min) (OR 2.79; 95% CI 0.70–11.1) but this difference was not statistically significant (p=0.14). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (>30 days and ≤90 days) (OR 5.38; 95% CI 1.32–21.9; p=0.01 and OR 0.09; 95% CI 0.01–0.76; p=0.02 respectively). There was a trend to significance regarding postoperative late complications (>90 days) (respectively OR 6.80; 95% CI 0.78–59.0; p=0.08 and OR 4.17; 95% CI 0.97–17.8; p=0.05). Sarcopenic status was not significantly associated with prognosis in terms of recurrence-free survival, specific survival or overall survival.
Conclusion : In the present study, we showed a significant variation of sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor significantly associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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Master Thesis
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Submitted on : Tuesday, October 15, 2019 - 6:17:07 PM
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Pierre Régnier. Impact de la sarcopénie sur la fonction rénale au cours de la chimiothérapie néoadjuvante et sur les complications post cystectomie des patients pris en charge pour une tumeur de la vessie infiltrant le muscle vésical localisée. Médecine humaine et pathologie. 2018. ⟨dumas-02317062⟩

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