Multicenter retrospective study of mortality prediction by sarcopenia with neoadjuvant chemotherapy in bladder cancer

The prognostic value of sarcopenia in bladder cancer patients undergoing neoadjuvant chemotherapy (NACT) remains underexplored. A multicenter retrospective study in France included 74 patients with invasive urothelial carcinoma treated with NACT followed by cystectomy between 2015 and 2021. Sarcopenia was assessed by measuring the Skeletal Muscle Index on CT scans before NACT (BC) and prior to surgery (BS). The primary endpoint was overall survival. Forty percent of patients achieved a pathologic complete response, 35% experienced disease recurrence, and the median progression-free survival was 25 months. Sarcopenia was observed in 27% of patients BC and 39% BS. Sarcopenia was associated with an increased risk of all-cause mortality: BC according to the definition of Martin et al (HR 3.38; p=0.016) and Fearon et al (HR 4.03; p=0.031) and BS according to Martin et al (HR 3.7; p=0.032) and Fearon et al (HR 6.08; p=0.012). Sarcopenia was also an independent risk factor of shorter PFS. The authors conclude that sarcopenia is an independent and reproducible prognostic factor for mortality receiving NACT for bladder cancer.