Burkay Çağatay TÖRER, Erdem KISA, Hilal ŞAHİN
Bulletin of Urooncology - 2026;25(2):38-46
Objective: To investigate the association between preoperative computed tomography (CT)-based abdominal muscle-fat composition and length of hospital stay, post-operative complications and cancer-specific survival in patients with bladder cancer undergoing radical cystectomy. Materials and Methods: Preoperative CT scans of 128 patients undergoing radical cystectomy for bladder cancer between 2013-2018 were reviewed. Densitometric quantification of total, visceral (VFA), subcutaneous (SFA) and inter-muscular fat-area (IMFA), mean muscle density (between -29HU and 150HU) (MD150) and muscle area (between -29HU and 150HU) (MA150) measurements were performed retrospectively on an axial CT image at the level of L3 vertebra. The length of hospital stays and Clavien-Dindo score was noted. In the survival analysis, 12- and 30-months were taken as the threshold values. The primary outcome measure was cancer-specific survival. Results: A total of 96 patients (92 men and 4 women, mean age 66 years, age range 49-86 years) were included. Patients with length of hospital stay more than 10 days had significantly higher VFA/SFA ratio (p=0.03) and higher IMFA (p=0.01). In the cohort, 74% of patients had low Clavien-Dindo scores (<=2) with significantly higher MA150 (p=0.02), MD150 (p<0.01) and lower IMFA (p=0.01) compared to group with high scores. In the survival analysis, MA150 and MD150 values were significantly higher (p=0.01 and p<0.01, respectively) in survivors more than 12 months. Only MD 150 value was significantly higher in survivors more than 30 months (p<0.01). Conclusion: Preoperative CT-based body composition parameters, particularly MD150 and MA150, can be used as non-invasive prognostic markers in patients undergoing radical cystectomy. These muscle-related parameters are strongly correlated with fewer surgical complications and longer cancer-specific survival, suggesting a promising role in preoperative risk stratification and patient support.
