PURPOSE We aimed to use a validated artificial intelligence (AI) algorithm to extract muscle and adipose areas from CT images before radical cystectomy (RCx) and then correlate these measures with 90-day post-RCx complications. MATERIALS AND METHODS A tertiary referral center's cystectomy registry was queried for patients who underwent RCx between 2009 and 2017 for bladder cancer. Eight hundred forty-three RCx patients with CT imaging within 90 days of preceding surgery were included, to allow for extraction of body composition parameters by AI. We assessed complications within 90 days of surgery including wound, infectious, and major complications; readmission; and death. Multivariable logistic regressions associated pre-RCx measures with post-RCx complications. RESULTS Increasing subcutaneous adipose tissue was associated with more wound complications, while patients with increasing visceral adipose tissue had greater odds of infectious-related complications. After adjusting for patient characteristics, every 10 cm2 increases in fat mass index were associated with more infectious (OR, 1.04; P = .002) and wound (OR, 1.06; P < .001) complications. On multivariable analysis, a higher preoperative skeletal muscle index was associated with lower odds of major complications (OR, 0.75 for every 10 cm2; P = .008), while higher intramuscular adipose was associated with higher odds of major complications (OR, 1.93; P = .008). CONCLUSIONS Automated AI body composition measurements preoperatively are associated with post-RCx complications. These measurements, in addition to patient (ECOG performance status and smoking status) and surgical (robotic approach and continent diversion) characteristics, can then be used to individualize patient counseling and facilitate triage of nutritional and rehabilitation efforts.

中文翻译：

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基于人工智能的术前身体成分评估与根治性膀胱切除术后的早期并发症相关。


目的 我们旨在使用经过验证的人工智能 （AI） 算法在根治性膀胱切除术 （RCx） 之前从 CT 图像中提取肌肉和脂肪区域，然后将这些措施与 RCx 后 90 天的并发症相关联。材料和方法 查询了 2009 年至 2017 年间因膀胱癌接受 RCx 的患者，三级转诊中心的膀胱切除术登记处。纳入 843 例在既往手术后 90 天内进行 CT 成像的 RCx 患者，以允许通过 AI 提取身体成分参数。我们评估了手术后 90 天内的并发症，包括伤口、感染和主要并发症;再入院;和死亡。多变量 logistic 回归将 RCx 前测量值与 RCx 后并发症相关联。结果 皮下脂肪组织增加与更多的伤口并发症相关，而内脏脂肪组织增加的患者发生感染相关并发症的几率更大。在调整患者特征后，脂肪量指数每增加 10 cm2 与更具传染性的相关性相关 （OR，1.04;P = .002） 和伤口 （OR， 1.06;P < .001） 并发症。在多变量分析中，较高的术前骨骼肌指数与较低的主要并发症几率相关（OR，每 10 cm2 0.75;P = .008），而较高的肌内脂肪与较高的主要并发症几率相关 （OR，1.93;P = .008）。结论 术前自动 AI 体成分测量与 RCx 后并发症相关。 除了患者 （ECOG 体能状态和吸烟状态） 和手术 （机器人入路和大陆分流） 特征外，这些测量结果还可用于个体化患者咨询并促进营养和康复工作的分类。