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Título

PSOAS MUSCLE INDEX AS ONCOLOGICAL PREDICTOR IN INVASIVE UROTHELIAL BLADDER CANCER

Resumo

1.Introduction: The preoperative nutritional status of patients with bladder cancer has a significant effect on the surgical outcome. However, there are few reports that study the Psoas Muscle Index (MPI), defined as the ratio between the area of the psoas muscle at the height of the third lumbar vertebra (L3) divided by its height. Currently, there are no studies in urology on the use of this index as a predictor of cancer outcomes. There are some reports showing little correlation with other known muscle-related indices (cross-sectional area and density). The aim of the present study was to correlate the PMI index of patients undergoing radical cystectomy for bladder cancer with their surgical outcomes.

2. Methods: From January 2009 to October 2022, 623 patients were treated from bladder to radical cystectomy. This is a retrospective study through a review of medical records in a tertiary cancer center. Univariate, Multivariate and Kaplan-Meier curves were used to confirm the predictability of the prognosis of MPI.

3. Results: Of the total of 623 patients with a mean follow-up of 40.7 months, 338 (54.25%) had recurrence and 287 (46.06%) died associated with the neoplasm. The mean PMI was 4.67 in patients who had tumor relapse, while in those who did not recur it was 5.25 (p<0.001). On the Kaplan-Meier curve, the PMI score was associated with cancer-specific survival (CSS), recurrence-free survival (RFS) and overall survival (OS), and all with log rank test showing P < 0.001. The PMI demonstrates a greater association between oncological symptoms when compared to the cross-sectional area or density of the psoas muscle.

4. Conclusions: In patients undergoing radical cystectomy for bladder cancer, the PMI score can be a significant predictor of tumor recurrence, progression, and mortality. The inclusion of the PMI score as a predictor may increase the accuracy of developing follow-up strategies and adjunctive therapies for patients with unfavorable PMI.