Lokalize Renal Hücreli Karsinomu Olan Hastalarda Psoas Kas İndeksi ve İskelet Kas İndeksine Dayalı Kas Kütlesinin Nüks ve Mortalite Riski ile İlişkisi: Kapsamlı Bir Retrospektif Analiz

Year 2025, Volume: 17 Issue: 3, 119 - 131, 30.09.2025

Yusuf Arıkan , Deniz Noyan Özlü , Büşra Emir , Hakan Polat , Mehmet Zeynel Keskin

https://doi.org/10.54233/endourolbull-1704160

Abstract

Amaç: Lokalize Renal Hücreli Karsinomlu (RHK) hastalarda Psoas Kas İndeksi (PMI) ve İskelet Kas İndeksi (SMI) ile nüks ve mortalite riski arasındaki ilişkiyi belirlemeyi amaçladık.
Gereç ve Yöntemler: SMI ve PMI değerleri, L3 seviyesindeki kesitlerde kontrastsız bilgisayarlı tomografi (BT) ölçümlerinden elde edildi ve yüksekliğe göre normalize edildi. Genel sağkalım (OS) ve nükssüz sağkalım (RFS) dahil olmak üzere mevcut sağkalım verileri ameliyat sonrası takipte toplandı. Hastalık nüksü BT, manyetik rezonans görüntüleme veya kemik taramasında hastalığın radyografik kanıtı olarak tanımlanmıştır.
Bulgular: ROC analizinde, PMI için optimal kesim değeri sırasıyla erkek ve kadın hastalarda ≤ 5,1 cm²/m² ve ≤ 3,1 cm²/m² iken, SMI için kesim değeri erkek ve kadın hastalarda ≤ 44 cm²/m² ve ≤ 30 cm²/m² idi. Çok değişkenli analizlerde, kadın cinsiyet, nüks, klinik T evresi ≥ T3b, patolojik T evresi ≥T3b ve PMI ve SMI’ye göre sarkopeni daha kötü OS ve RFS’nin bağımsız belirleyicileriydi (p<0,001). Kaplan-Meier analizinde, sarkopenisi olan ve olmayan hastalarda OS sırasıyla 74 vs 85 ay saptandı (p<0,001). RFS sarkopenisi olan hastalarda daha kısaydı (PMI: 76 vs 84, SMI: 74 vs 85 ay, her ikisi de p<0,001)
Sonuç: Lokalize RHK’li hastalarda sarkopeni daha erken nüks, daha kısa OS ve RFS ile ilişkiliydi. Sarkopenisi olan hastalar preoperatif evrelemede daha kötü prognoza sahipti.

Keywords

iskelet kası indeksi , psoas kas indeksi , renal hücreli karsinom , sarkopeni

Ethical Statement

Çalışma, İzmir Tepecik Eğitim ve Araştırma Hastanesi Etik Kurulu, İzmir, Türkiye tarafından onaylanmıştır (Karar No: 2024/07-14 Tarih: 19.08.2024).

Supporting Institution

Yazarlar, bu çalışmanın hiçbir finansal destek almadığını beyan etmişlerdir

Relationship of Muscle Mass Based on Psoas Muscle Index and Skeletal Muscle Index with Recurrence and Mortality Risk in Localized Renal Cell Carcinoma: A Comprehensive Retrospective Analysis

Abstract

Objective: We aimed to determine the relationship between the Psoas Muscle Index (PMI) and Skeletal Muscle Index (SMI) and the risk of recurrence and mortality in patients with localized Renal Cell Carcinoma (RCC).
Material and Methods: SMI and PMI values were obtained from non-contrast computed tomography (NCCT) measurements on slices at the L3 level, normalized by height. Available survival data, including overall survival (OS) and recurrence-free survival (RFS), were collected at postoperative follow-up. Disease recurrence was defined as radiological evidence of disease on computed tomography (CT), magnetic resonance imaging, or bone scan.
Results: In the ROC analysis, the optimal cut-off value for PMI was ≤ 5.1 cm²/m² and ≤ 3.1 cm²/m² in male and female patients, while the cut-off value for SMI was ≤ 44 cm²/m² and ≤ 30 cm²/m² in male and female patients. In multivariate analyses, female gender, recurrence, clinical T stage ≥ T3b, pathological T stage ≥T3b, and sarcopenia according to PMI and SMI were independent predictors of worse OS and RFS (p < 0.001). In Kaplan-Meier analysis, OS in patients with and without sarcopenia was 74 vs 85 months (p < 0.001), respectively. RFS were shorter in patients with sarcopenia (PMI: 76 vs 84, SMI: 74 vs 85 months, both p < 0.001)
Conclusion: In patients with localized RCC, sarcopenia was associated with earlier recurrence, shorter OS, and RFS. Patients with sarcopenia had a worse prognosis in preoperative staging.

Keywords

psoas muscle index , renal cell carcinoma , sarcopenia , skeletal muscle index

Ethical Statement

The study was approved by The University of Health Sciences, Izmir Tepecik Training and Research Hospital Ethical Committee, Izmir, Türkiye (Decision No: 2024/07-14 Date: 19.08.2024).

Supporting Institution

The authors declared that this study has received no financial support.

References

• 1. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, et al. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol. 2016 Oct;196(4):989-99. https://doi.org/10.1016/j.juro.2016.04.081
• 2. Chen S, He T, Sun S, Wu J, Xu B, et al. Prognostic Significance of Pre- to Postoperative Dynamics of Sarcopenia for Patients with Renal Cell Carcinoma Undergoing Laparoscopic Nephrectomy. Front Surg. 2022 Apr 21;9:871731. https://doi.org/10.3389/fsurg.2022.871731
• 3. P. Lakshmi Prashanthi, Rajoo Ramachandran, Adhilakshmi,Prabhu Radhan, Pm venkata sai. Standardization of PSOAS muscle index measurements using computed tomography. International Journal of Contemporary Medicine Surgery and Radiology. 2020;5:A169-A172.
• 4. Darbas T, Forestier G, Leobon S, Pestre J, Jesus P, et al. Impact of Body Composition in Overweight and Obese Patients With Localised Renal Cell Carcinoma. In Vivo. 2020;34:2873-2881. https://doi.org/10.21873/invivo.12115
• 5. Mao W, Wang K, Zhang H, Lu H, Sun S, et al. Sarcopenia as a poor prognostic indicator for renal cell carcinoma patients undergoing nephrectomy in China: A multicenter study. Clin Transl Med. 2021;11:e270. https://doi. org/10.1002/ctm2.270
• 6. Bahat G, Turkmen BO, Aliyev S, Catikkas NM, Bakir B, et al. Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass. Clin Nutr. 2021;40:4360-4365. https://doi.org/10.1016/j.clnu.2021.01.010
• 7. Psutka SP, Boorjian SA, Moynagh MR, Schmit GD, Costello BA, et al. Decreased Skeletal Muscle Mass is Associatedwith an Increased Risk of Mortality after Radical Nephrectomy for Localized Renal Cell Cancer. J Urol. 2016;195:270- 276. https://doi.org/10.1016/j.juro.2015.08.072
• 8. Ueki H, Hara T, Okamura Y, Bando Y, Terakawa T, et al. Association between sarcopenia based on psoas muscle index and the response to nivolumab in metastatic renal cell carcinoma: A retrospective study. InvestigClin Urol. 2022;63:415-424. https://doi.org/10.4111/icu.20220028
• 9. Ufuk F, Herek D. Reference skeletal muscle mass values at L3 Vertebrae level based on computed tomography in healthy Turkish adults. Int J Gerontol 2019;13:221e5
• 10. Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Shirai H, et al. Proposal for new selection criteria considering pretransplant muscularity and visceral adiposity in living donor liver transplantation. J Cachexia Sarcopenia Muscle. 2018;9:246e54. https://doi.org/10.1002/jcsm.12276
• 11. Yuxuan L, Junchao L, Wenya L. The role of sarcopenia in treatment-related outcomes in patients with renal cell carcinoma: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(43):e31332. https://doi. org/10.1097/MD.0000000000031332.
• 12. Peyton CC, Heavner MG, Rague JT, Krane LS, Hemal AK. Does Sarcopenia Impact Complications and Overall Survival in Patients Undergoing Radical Nephrectomy for Stage III and IV Kidney Cancer? J Endourol. 2016;30:229- 36. https://doi.org/10.1089/end.2015.0492.
• 13. Kim JS, Kim WY, Park HK, Kim MC, Jung W, et al. Simple age-specific cutoff value for sarcopenia evaluated by computed tomography. Ann NutrMetab 2017;71:157e63
• 14. Yildiz Tacar S, Yilmaz M, Tural D, Gulturk I, Orhan M, et al. Association of Low Muscle Mass as a Marker of Sarcopenia with Survival in Metastatic Renal Cell Carcinoma Patients Receiving Nivolumab. EJMI 2022;6:374–382.
• 15. Lee J, Suh J, Song C, You D, Jeong IG, et al. Association Between Sarcopenia and Survival of Patients with OrganConfined Renal Cell Carcinoma after Radical Nephrectomy. Ann Surg Oncol. 2022;29:2473-2479. https://doi. org/10.1245/s10434-021-10881-7..
• 16. Higgins MI, Martini DJ, Patil DH, Nabavizadeh R, Steele S, et al. Sarcopenia and modified Glasgow Prognostic Score predict postsurgical outcomes in localized renal cell carcinoma. Cancer. 2021;127:1974-1983. https://doi. org/10.1002/cncr.33462.
• 17. Makino T, Izumi K, Iwamoto H, Kadomoto S, Kadono Y, et al. Sarcopenia Is Associated with Aggressive Clinicopathological Outcomes and Is a Poor Prognostic Indicator for Non-metastatic Renal Cell Carcinoma. In Vivo. 2023;37:1304-1311. https://doi.org/10.21873/invivo.13209.
• 18. Noguchi G, Kawahara T, Kobayashi K, Tsutsumi S, Ohtake S, et al. A lower psoas muscle volume was associated with a higher rate of recurrence in male clear cell renal cell carcinoma. PLoS One. 2020;15:e0226581. https://doi. org/10.1371/journal.pone.0226581.
• 19. Hu Q, Mao W, Wu T, Xu Z, Yu J, et al. High neutrophil-tolymphocyte ratio and platelet-to-lymphocyte ratio are associated with sarcopenia risk in hospitalized renal cell carcinoma patients. Front Oncol. 2021;11:736640. https://doi.org/10.3389/fonc.2021.736640
• 20. Sharma P, Zargar-Shoshtari K, Caracciolo JT, Fishman M, Poch MA, et al. Sarcopenia as a predictor of overall survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Urol Oncol. 2015;33:339. e17-23. https://doi.org/10.1016/j.urolonc.2015.01.011
• 21. Fukushima H, Nakanishi Y, Kataoka M, Tobisu K, Koga F. Prognostic Significance of Sarcopenia in Patients with Metastatic Renal Cell Carcinoma. J Urol. 2016;195:26-32. https://doi.org/10.1016/j.juro.2015.08.071
• 22. Ishihara H, Kondo T, Omae K, Takagi T, Iizuka J, et al. Sarcopenia and the Modified Glasgow Prognostic Score are Significant Predictors of Survival Among Patients with Metastatic Renal Cell Carcinoma Who are Receiving FirstLine Sunitinib Treatment. Target Oncol. 2016;11:605-617. https://doi.org/10.1007/s11523-016-0430-0