Pre-operative CT-based abdominal muscle and fat distribution in patients with muscle-invasive bladder cancer
Number:28ESURABS0125
Type:Scientific Electronic Presentation
Authors: Cagatay Burkay Torer, Erdem Kisa, Hilal Sahin
Keywords:bladder cancer, muscle invasion, muscle-fat distribution
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Objectives

To investigate the association between preoperative CT-based abdominal muscle-fat composition and length of hospital stay, post-operative complications and long-term survival in patients with muscle-invasive bladder cancer undergoing radical cystectomy

Material and methods

This retrospective single center study was IRB approved.

128 patients undergoing radical cystectomy for muscle-invasive bladder cancer in our institution between May 2013 and June 2018 were reviewed. Routine computed tomography scans for staging were performed prior to surgery.

For the analysis of muscle-fat distribution, densitometric quantification of total (TFA), visceral (VFA), subcutaneous (SFA) and inter-muscular fat-area (IMFA), mean muscle density (MD150) and muscle-area (MA150) measurements were performed retrospectively on a single axial CT-image at the level of third lumbar vertebra using a commercially available software (Aquarius Workstation, TeraRecon, San Mateo, California, USA). 150 HU was taken as the upper threshold for muscle area and density measurements. An example of measurement of fat distribution is gien in Figure 1. 

The...

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Figure 1
Results

A total of 96 patients (92 men and 4 women) with a mean age of 66 years (range 49-86 years) were included in the final cohort. The histopathological data is given in Table 1. 

Patients with length of hospital stay more than 10 days had significantly higher VFA/SFA ratio (p=0.03) and higher IMFA (p=0.01) (Table 2).

Patients with low Clavien-Dindo scores (<3) had significantly higher MA150 (p=0.02), MD150 (p<0.01) and lower IMFA (p=0.01) (Table 3). 

During follow-up, 6 patients were deceased due to causes other than bladder cancer and they were excluded for the survival analysis. In the remaining cohort (90 patients), 7 patients were deceased in the first 10 days after surgery, 29 patients in the first 12 months and 11 patients between 12-30 months (Figure 2).

In the survival analysis, MA150 and MD150 values were significantly higher...

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Table 1
Table 2
Conclusions

Non-invasive and semiautomatic quantification of CT-based body composition parameters in the pre-operative CT scans may improve risk stratification in patients undergoing radical cystectomy.