Abstract
Introduction/Background
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.
Results
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).
Conclusion
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.
Keywords
Abbreviations:
PC-RPLND (Post-chemotherapy retroperitoneal lymph node dissection), PSI (Psoas Index), IGCCCG (International Germ Cell Cancer Collaborative Group), TPA (Total Psoas Area)To read this article in full you will need to make a payment
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References
- Guidelines on testicular cancer: 2015 update.Eur Urol. 2015; 68: 1054-1068https://doi.org/10.1016/j.eururo.2015.07.044
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.
- Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma.J Gastrointest Surg. 2012; 16: 1478-1486
- Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery.Br J Cancer. 2012; 107: 931-936
- 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
- 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
- Prognostic significance of sarcopenia in upper tract urothelial carcinoma patients treated with radical nephroureterectomy.Cancer Med. 2016; 5: 2213-2220
- 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
- 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
- Association of muscle mass with survival after radical prostatectomy in patients with prostate cancer.J Urol. 2019; 202: 525-530https://doi.org/10.1097/JU.0000000000000249
- Sarcopenia as a predictor of complications and survival following radical cystectomy.J Urol. 2014; 191: 1714-1720
- Sarcopenia evaluated using the skeletal muscle index is a significant prognostic factor for metastatic urothelial carcinoma.Clin Genitourin Cancer. 2016; 14: 237-243https://doi.org/10.1016/j.clgc.2015.07.015
- Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography.J Hepatol. 2014; 60: 1151-1157
- 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
- Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.J Appl Physiol. 2004; 97: 2333-2338
- Population-based study of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular germ cell tumors.Urology. 2009; 74: 373-377
- Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data.BJU Int. 2010; 105: 918-921
- Impact of hospital case volume on testicular cancer outcomes and practice patterns.Urol Oncol. 2018; 36: 14.e7-14.e15
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.
- Complications of post-chemotherapy retroperitoneal lymph node dissection for testis cancer.J Urol. 2004; 171: 1839-1841
- 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
- Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer.Clin Nutr. 2012; 31: 74-77
- The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases.HPB. 2017; 19: 331-337
- Sarcopenia as a comorbidity-independent predictor of survival following radical cystectomy for bladder cancer.J Cachexia Sarcopenia Muscle. 2018; 9: 505-513
- Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy.Ann Surg Oncol. 2016; 23: 1048-1054
- Sarcopenia adversely impacts postoperative complications following resection or transplantation in patients with primary liver tumors.J Gastrointest Surg. 2015; 19: 272-281
- Lower skeletal muscle index and early complications in patients undergoing radical cystectomy for bladder cancer.World J Surg Oncol. 2014; 12: 1-7
- 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
- Preoperative immunonutrition prior to radical cystectomy: a pilot study.Can J Urol. 2017; 24: 8895-8901
- Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer.Gastric Cancer. 2017; 20: 913-918
Article info
Publication history
Published online: June 10, 2022
Accepted:
June 7,
2022
Received:
March 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
