1210 - Sarcopenia and pretreatment anemia as prognostic factors for patients with localized muscle invasive bladder cancer treated by neoadjuvant chemotherapy and radical cystectomy

Background

Several studies suggested the prognostic importance of sarcopenia and anemia in survival or treatment complications in cancer. The aim of our study was to identify prognosis factors on chemotherapy toxicities and survival in patients (pts) with localized muscle invasive bladder cancer (MIBC).

Methods

Between January 2012 and December 2017, pts who underwent neoadjuvant platinum-based chemotherapy (NAC) followed by radical cystectomy (RC) for cT2-T4 N0 M0 MIBC were retrospectively selected, from a single institution cohort. Sarcopenia was evaluated according to the Lumbar Skeletal Muscle Index (SMI) in L3 using CT scan before NAC, after NAC and after RC. Pretreatment anemia was defined as hemoglobin rate < 13g/dL for men and < 12g/dL for women, prior to treatment.

Results

Of 82 pts selected, 62 are men (75.6%) and 20 women (24.4%), with a median age of 64.5 years (31 to 80). Median SMI was 47.5cm²/m² for men and 36.6 cm²/m² for women. Pretreatment sarcopenia was significantly associated with nausea (p = 0.003), hypokalemia (p = 0.023) and with platinum dose-intensity during NAC (p = 0.007). 46 out of 74 pts had a SMI decrease greater than 5% during chemotherapy, that was associated with poor OS (HR = 4.8, CI95% [1.42-16.4], p = 0.003). Pretreatment anemia was significantly associated with OS (HR = 2.86, CI95% [1.21-6.76], p = 0.026). Transfusion during chemotherapy was not associated with survival. In multivariate analysis, factors associated with OS were SMI loss > 5% (HR = 4.62, CI95% [1,25-11,9]), positive pN status (HR = 7.66, CI95% [2,53-23,1]), histological complete response (HR = 0.22, CI95% [0,053-0,88]), pretreatment anemia (HR = 7.34, CI95% [2,26-23,8]) and ECOG status ≥ 1 (HR = 4.1, CI95% [1,41-11,9]).

Conclusions

For localized MIBC, sarcopenic status before NAC could predict some chemotherapy toxicities whereas pretreatment anemia could be associated with poor OS. Loss in SMI during chemotherapy is an independent prognostic factor for OS. Improve pts care by prehabilitation during NAC and before surgery, using physical, nutritional and psycho-social supports, could decrease chemotherapy toxicities and improve survival.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Institut Paoli-Calmettes.

Funding

Has not received any funding.

Disclosure

J. Walz: Research grant / Funding (self): Exact Imaging; Honoraria (self), Speaker Bureau / Expert testimony: Janssen; Honoraria (self), Speaker Bureau / Expert testimony: Takeda; Honoraria (self), Speaker Bureau / Expert testimony: AstraZeneca; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Blue Earth Diagnostics; Travel / Accommodation / Expenses: Ipsen. S. Dermeche: Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: AstraZeneca. C. Vicier: Travel / Accommodation / Expenses: Astellas; Travel / Accommodation / Expenses: Pfizer. G. Pignot: Advisory / Consultancy, Travel / Accommodation / Expenses: Janssen; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Astellas; Advisory / Consultancy: BMS; Advisory / Consultancy: Roche; Advisory / Consultancy: Bouchara; Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: Takeda. All other authors have declared no conflicts of interest.