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Effect of Changes in Skeletal Muscle Mass on Oncological Outcomes During First-Line Sunitinib Therapy for Metastatic Renal Cell Carcinoma

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Abstract

Background

Sarcopenia is a state of degenerative skeletal muscle wasting induced by cancer cachexia.

Objective

To evaluate the prognostic impact of changes in skeletal muscle mass (SMM) during first-line sunitinib therapy on oncological outcomes in metastatic renal cell carcinoma (mRCC).

Patients and Methods

Sixty-nine patients were evaluated retrospectively. The skeletal muscle index (SMI) was calculated based on computed tomography images obtained before the initiation (pre-treatment SMI) and after two cycles of sunitinib treatment (post-treatment SMI). The change in SMM was evaluated based on the value of ΔSMI, which was calculated as [(posttreatment SMI – pretreatment SMI)/ pretreatment SMI] × 100. Oncological outcomes were compared between patients with ΔSMI <0 (SMM decrease) and ΔSMI ≥0 (SMM maintenance).

Results

A decrease in SMM was observed in 38 patients (55.1%). Progression-free survival (PFS) and overall survival (OS) after sunitinib therapy initiation were significantly shorter in patients with ΔSMI <0 than in those with ΔSMI ≥0 (median PFS: 9.53 vs. 28.4 months, p < 0.0001; OS: 19.8 vs. 52.6 months, p = 0.0001). ΔSMI was an independent predictive factor for PFS (HR 3.25, 95% CI 1.74–6.29, p = 0.0002) and OS (HR 4.53, 95% CI 2.15–10.5, p < 0.0001). The objective response rate was significantly lower in patients with ΔSMI <0 than in those with ΔSMI ≥0 (23.7% vs. 51.6%, p = 0.0164).

Conclusion

Decreased SMM during first-line sunitinib therapy can be an effective marker of outcome prediction for mRCC.

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Acknowledgements

The authors thank Nobuko Hata for providing secretarial assistance.

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Authors and Affiliations

  1. Department of Urology, Kidney Center, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Hiroki Ishihara, Toshio Takagi, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka & Kazunari Tanabe

  2. Department of Urology, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan

    Tsunenori Kondo

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  1. Hiroki Ishihara
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Correspondence to Hiroki Ishihara.

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No external funding was used in the preparation of this manuscript.

Conflict of Interest

Tsunenori Kondo received honoraria from Pfizer, Bayer, and Novartis. All other authors including Hiroki Ishihara, Toshio Takagi, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, and Kazunari Tanabe declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Ishihara, H., Takagi, T., Kondo, T. et al. Effect of Changes in Skeletal Muscle Mass on Oncological Outcomes During First-Line Sunitinib Therapy for Metastatic Renal Cell Carcinoma. Targ Oncol 13, 745–755 (2018). https://doi.org/10.1007/s11523-018-0600-3

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  • DOI: https://doi.org/10.1007/s11523-018-0600-3

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