Skip to main content

Advertisement

SpringerLink
Log in

Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

We aimed to investigate the impact of postoperative weight loss following radical cystectomy (RC) on patients’ prognoses. RC and urinary diversion were performed in 512 consecutive patients with muscle-invasive bladder cancer at our hospitals between May 1996 and July 2018. Demographic clinical information, pre- and postoperative serum albumin, hemoglobin, and weight were evaluated retrospectively at 1 month. We also evaluated the association of weight loss with complications and overall survival (OS) as estimated using the Kaplan–Meier method and compared using the log-rank test. Risk factors for poor OS were determined by Inverse Probability of Treatment Weighted (IPTW)-adjusted Cox regression analysis. In 385 patients who met the study search criteria, median postoperative weight loss from baseline at 1 week and 1 month was 1.1 (− 1.8%) and 3.2 (− 5.4%) kg, respectively. Patients with significant weight loss (defined as ≥ 7.5% at 1 month) had higher-grade complications within 1 month and had significantly shorter OS than those with weight loss of < 7.5%. Type of urinary diversion, loss of serum albumin, and loss of hemoglobin were not significantly associated with weight loss. IPTW-adjusted Cox regression analysis showed that such significant weight loss was an independent risk factor for poor OS. Weight loss followed by radical cystectomy was significantly associated with poor prognosis in patients with muscle-invasive bladder cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute-lessons to be learned. J Urol. 2006;176(1):161–6. https://doi.org/10.1016/s0022-5347(06)00573-8.

    Article  PubMed  Google Scholar 

  2. Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207–12. https://doi.org/10.1016/j.juro.2011.02.006.

    Article  PubMed  Google Scholar 

  3. Koie T, Ohyama C, Yamamoto H, Hatakeyama S, Kudoh S, Yoneyama T, et al. Minimum incision endoscopic radical cystectomy in patients with malignant tumors of the urinary bladder: clinical and oncological outcomes at a single institution. Eur J Surg Oncol. 2012;38(11):1101–5. https://doi.org/10.1016/j.ejso.2012.07.115.

    Article  CAS  PubMed  Google Scholar 

  4. Kanno T, Kobori G, Shibasaki N, Moroi S, Akao T, Yamada H. Laparoscopic intracorporeal ileal conduit after laparoscopic radical cystectomy: a modified technique to facilitate ureteroenteric anastomosis. Int J Urol. 2018. https://doi.org/10.1111/iju.13782.

    Article  PubMed  Google Scholar 

  5. Koie T, Ohyama C, Yoneyama T, Nagasaka H, Yamamoto H, Imai A, et al. Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes. Int J Med Robot. 2018:e1955. https://doi.org/10.1002/rcs.1955.

  6. Tyritzis SI, Wiklund NP. Is the open cystectomy era over? An update on the available evidence. Int J Urol. 2018;25(3):187–95. https://doi.org/10.1111/iju.13497.

    Article  PubMed  Google Scholar 

  7. Inamoto T, Ibuki N, Komura K, Juri H, Yamamoto K, Yamamoto K, et al. Can bladder preservation therapy come to the center stage? Int J Urol. 2018;25(2):134–40. https://doi.org/10.1111/iju.13495.

    Article  PubMed  Google Scholar 

  8. Vidal A, Arnold N, Vartolomei MD, Kiss B, Burkhard F, Thalmann GN, et al. Oncological and functional outcomes of postoperative total parenteral nutrition after radical cystectomy in bladder cancer patients: a single-center randomized trial. Int J Urol. 2016;23(12):992–9. https://doi.org/10.1111/iju.13228.

    Article  PubMed  Google Scholar 

  9. Osawa T, Abe T, Takada N, Ito YM, Murai S, Shinohara N. Validation of the nomogram for predicting 90-day mortality after radical cystectomy in a Japanese cohort. Int J Urol. 2018;25(7):699–700. https://doi.org/10.1111/iju.13584.

    Article  PubMed  Google Scholar 

  10. McDonald ML, Liss MA, Nseyo UU, Gal DB, Kane CJ, Kader AK. Weight loss following radical cystectomy for bladder cancer: characterization and effect on survival. Clin Genitourin Cancer. 2017;15(1):86–92. https://doi.org/10.1016/j.clgc.2016.06.009.

    Article  PubMed  Google Scholar 

  11. Rosenbaum K, Wang J, Pierson RN Jr, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPEN J Parenter Enteral Nutr. 2000;24(2):52–5. https://doi.org/10.1177/014860710002400252.

    Article  CAS  PubMed  Google Scholar 

  12. Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2015;44(1):148–52. https://doi.org/10.1093/ageing/afu157.

    Article  PubMed  Google Scholar 

  13. Soma O, Hatakeyama S, Okamoto T, Fujita N, Matsumoto T, Tobisawa Y, et al. Clinical implication of a quantitative frailty assessment tool for prognosis in patients with urological cancers. Oncotarget. 2018;9(25). https://doi.org/10.18632/oncotarget.24712.

  14. Johnson DC, Riggs SB, Nielsen ME, Matthews JE, Woods ME, Wallen EM, et al. Nutritional predictors of complications following radical cystectomy. World J Urol. 2015;33(8):1129–37. https://doi.org/10.1007/s00345-014-1409-z.

    Article  CAS  PubMed  Google Scholar 

  15. Momota M, Hatakeyama S, Tokui N, Sato T, Yamamoto H, Tobisawa Y, et al. The impact of preoperative severe renal insufficiency on poor postsurgical oncological prognosis in patients with urothelial carcinoma. Eur Urol Focus. 2018. https://doi.org/10.1016/j.euf.2018.03.003.

    Article  PubMed  Google Scholar 

  16. Horiguchi H, Yoneyama T, Hatakeyama S, Tokui N, Sato T, Fujita N, et al. Impact of bacillus Calmette–Guerin therapy of upper urinary tract carcinoma in situ: comparison of oncological outcomes with radical nephroureterectomy. Med Oncol. 2018;35(4):41. https://doi.org/10.1007/s12032-018-1102-y.

    Article  CAS  PubMed  Google Scholar 

  17. Kido K, Hatakeyama S, Fujita N, Yamamoto H, Tobisawa Y, Yoneyama T, et al. Oncologic outcomes for open and laparoscopic radical nephroureterectomy in patients with upper tract urothelial carcinoma. Int J Clin Oncol. 2018. https://doi.org/10.1007/s10147-018-1248-9.

    Article  PubMed  Google Scholar 

  18. Koie T, Ohyama C, Hashimoto Y, Hatakeyama S, Yamamoto H, Yoneyama T, et al. Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: a prospective single-arm study. Int J Clin Oncol. 2013;18(4):724–30. https://doi.org/10.1007/s10147-012-0447-z.

    Article  CAS  PubMed  Google Scholar 

  19. Anan G, Hatakeyama S, Fujita N, Iwamura H, Tanaka T, Yamamoto H, et al. Trends in neoadjuvant chemotherapy use and oncological outcomes for muscle-invasive bladder cancer in Japan: a multicenter study. Oncotarget. 2017;8(49):86130–42. https://doi.org/10.18632/oncotarget.20991.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Koie T, Ohyama C, Yamamoto H, Imai A, Hatakeyama S, Yoneyama T, et al. Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T2 bladder cancer. Med Oncol. 2014;31(5):949. https://doi.org/10.1007/s12032-014-0949-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Li J, Cheng Y, Liu G, Ji Z. The association of pretreatment serum albumin with outcomes in bladder cancer: a meta-analysis. Onco Targets Ther. 2018;11:3449–59. https://doi.org/10.2147/ott.s162066.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hernandez Torres C, Hsu T. Comprehensive geriatric assessment in the older adult with cancer: a review. Eur Urol Focus. 2017;3(4–5):330–9. https://doi.org/10.1016/j.euf.2017.10.010.

    Article  PubMed  Google Scholar 

  23. Chappidi MR, Kates M, Patel HD, Tosoian JJ, Kaye DR, Sopko NA, et al. Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy. Urol Oncol. 2016;34(6):256 e1–6. https://doi.org/10.1016/j.urolonc.2015.12.010.

    Article  Google Scholar 

  24. Sato T, Hatakeyama S, Okamoto T, Yamamoto H, Hosogoe S, Tobisawa Y, et al. Slow gait speed and rapid renal function decline are risk factors for postoperative delirium after urological surgery. PLoS ONE. 2016;11(5):e0153961. https://doi.org/10.1371/journal.pone.0153961.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial. Scand J Urol. 2015;49(2):133–41. https://doi.org/10.3109/21681805.2014.967810.

    Article  PubMed  Google Scholar 

  26. Rammant E, Decaestecker K, Bultijnck R, Sundahl N, Ost P, Pauwels NS, et al. A systematic review of exercise and psychosocial rehabilitation interventions to improve health-related outcomes in patients with bladder cancer undergoing radical cystectomy. Clin Rehabil. 2018;32(5):594–606. https://doi.org/10.1177/0269215517746472.

    Article  PubMed  Google Scholar 

  27. Wynter-Blyth V, Moorthy K. Prehabilitation: preparing patients for surgery. BMJ. 2017;358:j3702. https://doi.org/10.1136/bmj.j3702.

    Article  PubMed  Google Scholar 

  28. Di Rollo D, Mohammed A, Rawlinson A, Douglas-Moore J, Beatty J. Enhanced recovery protocols in urological surgery: a systematic review. Can J Urol. 2015;22(3):7817–23.

    PubMed  Google Scholar 

  29. Pang KH, Groves R, Venugopal S, Noon AP, Catto JWF. Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy. Eur Urol. 2017. https://doi.org/10.1016/j.eururo.2017.07.031.

    Article  PubMed  Google Scholar 

  30. Jensen BT, Lauridsen SV, Jensen JB. Prehabilitation for major abdominal urologic oncology surgery. Curr Opin Urol. 2018;28(3):243–50. https://doi.org/10.1097/mou.0000000000000487.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Teppei Okamoto, Teppei Matsumoto, Osamu Soma, Itsuto Hamano, Hiromichi Iwamura, Takuma Narita, Yuki Fujita, Yukie Nishizawa, and Satomi Sakamoto for their invaluable support with data collection. The authors would also like to thank Enago (http://www.enago.jp) for English language review.

Funding

This work was supported by a Grant-in-Aid for Scientific Research (Grant Nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, 17K16771, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.

Author information

Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan

    Kazutaka Okita, Shingo Hatakeyama, Naoki Fujita, Sakae Konishi, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto & Chikara Ohyama

  2. Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan

    Hiroyuki Ito

  3. Department of Urology, Mutsu General Hospital, Mutsu, Japan

    Kazuaki Yoshikawa

  4. Department of Urology, Gifu University Graduate School of Medicine, Hirosaki, Japan

    Takuya Koie

Authors
  1. Kazutaka Okita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shingo Hatakeyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoki Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sakae Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hayato Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Atsushi Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahiro Yoneyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuhiro Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroyuki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuaki Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takuya Koie
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Chikara Ohyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shingo Hatakeyama.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okita, K., Hatakeyama, S., Fujita, N. et al. Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer. Med Oncol 36, 7 (2019). https://doi.org/10.1007/s12032-018-1232-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-018-1232-2

Keywords

Search

Navigation