Association between sarcopenia based on psoas muscle index and the response to nivolumab in metastatic renal cell carcinoma: A retrospective study
Purpose: Two methods are used to identify sarcopenia by calculating skeletal muscle area on computed tomography: the skeletal muscle index (SMI) and the psoas muscle index (PMI). Programmed death (PD)-1 inhibitors are helpful in treating metastatic renal cell carcinoma (mRCC). However, there remains...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Urological Association
2022-07-01
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| Series: | Investigative and Clinical Urology |
| Subjects: | |
| Online Access: | https://www.icurology.org/pdf/10.4111/icu.20220028 |
| Summary: | Purpose: Two methods are used to identify sarcopenia by calculating skeletal muscle area on computed tomography: the skeletal muscle index (SMI) and the psoas muscle index (PMI). Programmed death (PD)-1 inhibitors are helpful in treating metastatic renal cell carcinoma (mRCC). However, there remains insufficient information regarding a clear and easy-to-use biomarker for predicting the response to PD-1 inhibitors in patients with mRCC. Therefore, we investigated the influence of sarcopenia on clinical outcomes in patients with mRCC undergoing treatment with nivolumab.
Materials and Methods: This study evaluated 96 patients with RCC who received nivolumab. The SMI and PMI were calculated for each patient and normalized for stature by use of the following formulas: SMI (cm2/m2)=([skeletal muscle cross-sectional area at the level of L3]/[height]2) and PMI (cm2/m2) = ([left-right sum of the psoas muscle areas at the level of L3]/[height]2). The relationship of the clinical variables with progression-free survival and overall survival (OS) was examined using a Cox proportional hazards model.
Results: According to the SMI-based definition of sarcopenia, 74.0% of patients had sarcopenia. However, according to the PMI-based definition of sarcopenia, only 34.3% of patients were diagnosed with sarcopenia. Multivariate analysis identified sarcopenia based on PMI (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.04–7.26; p<0.001) and International Metastatic RCC Database Consortium poor risk status (HR, 1.90; 95% CI, 1.03–3.50; p=0.041) as significant and independent prognostic factors of OS.
Conclusions: PMI-based sarcopenia is a significant prognostic factor for OS in patients with RCC who receive nivolumab therapy. |
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| ISSN: | 2466-0493 2466-054X |