Original Study| Volume 20, ISSUE 6, e460-e464, December 2022

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Decreased Muscle Mass Prior to and Following Chemotherapy Predicts Morbidity in Testicular Cancer Patients Undergoing Post-Chemotherapy Retroperitoneal Lymph Node Dissection



      The importance of nutritional status before oncologic surgery has been demonstrated in several solid malignancies. Testicular cancer primarily effects young men, and therefore clinicians may not consider sarcopenia as a factor in this population. We therefore sought to determine the impact of decreased muscle mass, measured by psoas muscle diameter, on outcomes in patients undergoing post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) for metastatic germ cell tumors (mGCTs).

      Materials and Methods

      Records of all patients undergoing PC-RPLND for mGCTs at our institution were reviewed. Muscle mass was assessed by measuring cross-sectional area of the psoas muscle on pre-chemotherapy and pre-operative computerized tomography. Psoas Index (PSI) was calculated by adjusting total psoas area for patient height (cm2/m2). Univariate and multivariate analysis was performed to assess the predictive value of sarcopenia for morbidity and mortality following PC-RPLND.


      From 2014-2019, 95 patients underwent PC-RPLND, of whom 64 patients had both pre-chemo and pre-operative cross-sectional imaging. Prior to chemotherapy, mean PSI was 7.36 cm2/m2, which decreased to 7.06 cm2/m2 (P = .041) following chemotherapy. Patients with Stage III disease had a lower mean PSI than patients with Stage I disease (6.84 cm2/m2 vs 7.46 cm2/m2, P = .047). Patients who suffered post-operative complications had a lower mean PSI (6.39 cm2/m2 vs 7.37 cm2/m2, P = .020).


      Decreased muscle mass was predictive of morbidity in patients undergoing PC-RPLND. Patients with higher disease burden had lower pre-operative muscle mass. Further assessment of pre-operative nutritional status in this population may reduce morbidity following PC-RPLND.



      PC-RPLND (Post-chemotherapy retroperitoneal lymph node dissection), PSI (Psoas Index), IGCCCG (International Germ Cell Cancer Collaborative Group), TPA (Total Psoas Area)
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        • Albers P
        • Albrecht W
        • Algaba F
        • et al.
        Guidelines on testicular cancer: 2015 update.
        Eur Urol. 2015; 68: 1054-1068
      1. Stephenson A, Eggener SE, Bass EB, et al. Diagnosis and treatment of early stage testicular cancer: AUA guideline. J Urol2019; 202(2):272-81. doi:10.1097/JU.0000000000000318.

        • Peng P
        • Hyder O
        • Firoozmand A
        • et al.
        Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma.
        J Gastrointest Surg. 2012; 16: 1478-1486
        • Lieffers JR
        • Bathe OF
        • Fassbender K
        • Winget M
        • Baracos VE.
        Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery.
        Br J Cancer. 2012; 107: 931-936
        • Prado CMM
        • Lieffers JR
        • McCargar LJ
        • et al.
        Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.
        Lancet Oncol. 2008; 9: 629-635
        • Ishihara H
        • Kondo T
        • Omae K
        • et al.
        Sarcopenia predicts survival outcomes among patients with urothelial carcinoma of the upper urinary tract undergoing radical nephroureterectomy: a retrospective multi-institution study.
        Int J Clin Oncol. 2017; 22: 136-144
        • Fukushima H
        • Nakanishi Y
        • Kataoka M
        • ichi Tobisu K
        • Koga F
        Prognostic significance of sarcopenia in upper tract urothelial carcinoma patients treated with radical nephroureterectomy.
        Cancer Med. 2016; 5: 2213-2220
        • Psutka SP
        • Boorjian SA
        • Moynagh MR
        • et al.
        Decreased skeletal muscle mass is associated with an increased risk of mortality after radical nephrectomy for localized renal cell cancer.
        J Urol. 2016; 195: 270-276
        • Watanabe S
        • Ishihara H
        • Takagi T
        • et al.
        Impact of sarcopenia on post-operative outcomes following nephrectomy and tumor thrombectomy for renal cell carcinoma with inferior vena cava thrombus.
        Jpn J Clin Oncol. 2021; 51: 819-825
        • Pak S
        • Park SY
        • Shin TJ
        • et al.
        Association of muscle mass with survival after radical prostatectomy in patients with prostate cancer.
        J Urol. 2019; 202: 525-530
        • Smith AB
        • Deal AM
        • Yu H
        • et al.
        Sarcopenia as a predictor of complications and survival following radical cystectomy.
        J Urol. 2014; 191: 1714-1720
        • Taguchi S
        • Akamatsu N
        • Nakagawa T
        • et al.
        Sarcopenia evaluated using the skeletal muscle index is a significant prognostic factor for metastatic urothelial carcinoma.
        Clin Genitourin Cancer. 2016; 14: 237-243
        • Durand F
        • Buyse S
        • Francoz C
        • et al.
        Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography.
        J Hepatol. 2014; 60: 1151-1157
        • Mourtzakis M
        • Prado CMM
        • Lieffers JR
        • Reiman T
        • McCargar LJ
        • Baracos VE.
        A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care.
        Appl Physiol Nutr Metab. 2008; 33: 997-1006
        • Shen W
        • Punyanitya M
        • Wang Z
        • et al.
        Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.
        J Appl Physiol. 2004; 97: 2333-2338
        • Capitanio U
        • Jeldres C
        • Perrotte P
        • et al.
        Population-based study of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular germ cell tumors.
        Urology. 2009; 74: 373-377
        • Williams SB
        • McDermott DW
        • Winston D
        • et al.
        Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data.
        BJU Int. 2010; 105: 918-921
        • Woldu SL
        • Matulay JT
        • Clinton TN
        • et al.
        Impact of hospital case volume on testicular cancer outcomes and practice patterns.
        Urol Oncol. 2018; 36: 14.e7-14.e15
      2. Ruf CG, Krampe S, Matthies C, et al. Major complications of post-chemotherapy retroperitoneal lymph node dissection in a contemporary cohort of patients with testicular cancer and a review of the literature. World J Surg Oncol2020;18(1):253. doi:10.1186/s12957-020-02032-1.

        • Mosharafa AA
        • Foster RS
        • Koch MO
        • Bihrle R
        • Donohue JP.
        Complications of post-chemotherapy retroperitoneal lymph node dissection for testis cancer.
        J Urol. 2004; 171: 1839-1841
        • Yip C
        • Goh V
        • Davies A
        • et al.
        Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer.
        Eur Radiol. 2014; 24: 998-1005
        • Awad S
        • Tan BH
        • Cui H
        • et al.
        Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer.
        Clin Nutr. 2012; 31: 74-77
        • Eriksson S
        • Nilsson JH
        • Holka PS
        • Eberhard J
        • Keussen I
        • Sturesson C.
        The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases.
        HPB. 2017; 19: 331-337
        • Mayr R
        • Gierth M
        • Zeman F
        • et al.
        Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer.
        J Cachexia Sarcopenia Muscle. 2018; 9: 505-513
        • Hirasawa Y
        • Nakashima J
        • Yunaiyama D
        • et al.
        Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy.
        Ann Surg Oncol. 2016; 23: 1048-1054
        • Valero V
        • Amini N
        • Spolverato G
        • et al.
        Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors.
        J Gastrointest Surg. 2015; 19: 272-281
        • Wan F
        • Zhu Y
        • Gu C
        • et al.
        Lower skeletal muscle index and early complications in patients undergoing radical cystectomy for bladder cancer.
        World J Surg Oncol. 2014; 12: 1-7
        • Portal D
        • Hofstetter L
        • Eshed I
        • et al.
        L3 skeletal muscle index (L3SMI) is a surrogate marker of sarcopenia and frailty in non-small cell lung cancer patients.
        Cancer Manag Res. 2019; 11: 2579
        • Lyon TD
        • Turner II
        • McBride D
        • et al.
        Preoperative immunonutrition prior to radical cystectomy: a pilot study.
        Can J Urol. 2017; 24: 8895-8901
        • Yamamoto K
        • Nagatsuma Y
        • Fukuda Y
        • et al.
        Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer.
        Gastric Cancer. 2017; 20: 913-918