ObjectivesTo assess whether the effect of sarcopenia on neoadjuvant chemotherapy (NAC) toxicity is modified by borderline renal function (estimated glomerular filtration rate [eGFR] 40–65 mL/min) and whether sarcopenia and borderline renal function are independently associated with NAC toxicity risk.Patients and MethodsAll patients with muscle‐invasive bladder cancer (MIBC) who underwent radical cystectomy (RC) between 2010 and 2022, with available cross‐sectional imaging prior to NAC initiation, were included. Skeletal mass was measured from axial computed tomography images obtained at the level of the L3 vertebral body, using Aquarius Intuition software. Sarcopenia was assigned based on consensus definitions of skeletal mass index. NAC toxicity was graded according to Common Terminology Criteria for Adverse Events version 5.0. Binary logistic regression was used to identify the predictors of NAC‐associated renal toxicity.ResultsA total of 216 patients were included. Most patients had sarcopenia (83%) and received gemcitabine/cisplatin NAC (76%). In an unadjusted model, sarcopenia was associated with a significant risk of renal‐associated NAC toxicity (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.65–14.44; P = 0.004). In an effect modification model evaluating the interaction between sarcopenia and renal function, the OR for renal toxicity with sarcopenia among patients with eGFR 40–65 mL/min was 8.46 (95% CI 1.06–67.72) vs 3.11 (95% CI 0.81–11.88) among patients with normal renal function (P = 0.43).ConclusionAmong MIBC patients who received NAC, sarcopenia was associated with higher odds of NAC‐associated renal toxicity and may increase risk of renal toxicity among patients with borderline renal function.

中文翻译：

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肌肉减少症可能增加肾功能交界性膀胱癌患者的顺铂毒性


目的评估肌少症对新辅助化疗 （NAC） 毒性的影响是否受临界肾功能 （估计肾小球滤过率 [eGFR] 40-65 mL/min） 的改变，以及肌少症和临界肾功能是否与 NAC 毒性风险独立相关。患者和方法纳入 2010 年至 2022 年间接受根治性膀胱切除术 （RC） 的所有肌层浸润性膀胱癌 （MIBC） 患者，在 NAC 开始前有可用的横断面成像。使用 Aquarius Intuition 软件，从 L3 椎体水平获得的轴向计算机断层扫描图像测量骨骼质量。根据骨骼质量指数的共识定义分配肌肉减少症。NAC 毒性根据不良事件通用术语标准 5.0 版进行分级。二元 logistic 回归用于确定 NAC 相关肾毒性的预测因子。结果共纳入 216 例患者。大多数患者患有肌肉减少症 （83%） 并接受吉西他滨/顺铂 NAC （76%）。在未经调整的模型中，肌肉减少症与肾脏相关 NAC 毒性的显著风险相关 （比值比 [OR] 4.88,95% 置信区间 [CI] 1.65-14.44;P = 0.004）。在评估肌肉减少症与肾功能之间相互作用的效应修饰模型中，eGFR 为 40-65 mL/min 的患者肌肉减少症肾毒性的 OR 为 8.46 （95% CI 1.06-67.72） vs 3.11 （95% CI 0.81-11.88） 肾功能正常的患者 （P = 0.43）。结论在接受 NAC 治疗的 MIBC 患者中，肌肉减少与 NAC 相关肾毒性的几率较高相关，并可能增加临界肾功能患者发生肾毒性的风险。