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. 2021 Dec 14;13(12):4471.
doi: 10.3390/nu13124471.

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

Sharon Cohen  1   2 , Jonathan Gal  2   3 , Yuval Freifeld  4   5 , Sobhi Khoury  4   5 , Yoram Dekel  4   5 , Azik Hofman  5   6   7 , Kamil Malshi  5   6 , Gilad Amiel  5   6   7 , Itay Sagi  2   7   8 , Ilan Leibovici  2   8 , Shay Golan  2   7   9 , Jack Baniel  2   9 , Barak Rozenzweig  1   2   7 , Zohar Dotan  1   2 , Miki Haifler  1   2   7
Affiliations

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications

Sharon Cohen et al. Nutrients. .

Abstract

Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity.

Materials and methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes.

Results: Ninety-one patients were included in the study. The median SMI change was -0.71 (-1.58, -0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (-18 vs. -203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively.

Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

Keywords: complication; nutrition; radical cystectomy; sarcopenia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PMA measurements at the L3 vertebrae.
Figure 2
Figure 2
SMI change during NAC across the complication groups. SMI change was significantly lower in patients with complications.
Figure 3
Figure 3
SMI change accuracy in predicting complications in univariable models.
Figure 4
Figure 4
SMI change based multivariable models’ accuracy in predicting complications.
See this image and copyright information in PMC

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