PURPOSE:Manual measurement of body composition on computed tomography (CT) is time-consuming, limiting its clinical use. We validate a software program, Automatic Body composition Analyzer using Computed tomography image Segmentation (ABACS), for the automated measurement of body composition by comparing its performance to manual segmentation in a cohort of patients with bladder cancer.METHOD:We performed a retrospective analysis of 285 patients treated for bladder cancer at the Duke University Health System from 1996 to 2017. Abdominal CT images were manually segmented at L3 using Slice-O-Matic. Automated segmentation was performed with ABACS on the same L3-level images. Measures of interest were skeletal muscle (SM) area, subcutaneous adipose tissue (SAT) area, and visceral adipose tissue (VAT) area. SM index, SAT index, and VAT index were calculated by dividing component areas by patient height2 (m2). Patients were dichotomized as sarcopenic, having excessive subcutaneous fat, or having excessive visceral fat using published cut-off values. Agreement between manual and automated segmentation was assessed using the Pearson product-moment correlation coefficient (PPMCC), the interclass correlation coefficient (ICC3), and the kappa statistic (κ).RESULTS:There was strong agreement between manual and automatic segmentation, with PPMCCs > 0.90 and ICC3s > 0.90 for SM, SAT, and VAT areas. Categorization of patients as sarcopenic (κ = 0.73), having excessive subcutaneous fat (κ = 0.88), or having excessive visceral fat (κ = 0.90) displayed high agreement between methods.CONCLUSIONS:Automated segmentation of body composition measures on CT using ABACS performs similarly to manual analysis and may expedite data collection in body composition research.

Background: There is limited understanding about why sarcopenia is happening in bladder cancer, and which modifiable and nonmodifiable patient-level factors affect its occurrence. Objective: The objective is to determine the extent to which nonmodifiable risk factors, modifiable lifestyle risk factors, or cancer-related factors are determining body composition changes and sarcopenia in bladder cancer survivors. Design, setting, and participants: Patients above 18 yr of age with a histologically confirmed diagnosis of bladder cancer and a history of receiving care at Duke University Medical Center between January 1, 1996 and June 30, 2017 were included in this study. Outcome measurements and statistical analysis: Bladder cancer survivors from our institution were assessed for their dietary intake patterns utilizing the Diet History Questionnaire II (DHQ-II) and physical activity utilizing the International Physical Activity Questionnaire long form (IPAQ-L) tools. Healthy Eating Index 2010 (HEI2010) scores were calculated from DHQ-II results. Body composition was evaluated using Slice-O-Matic computed tomography scan image analysis at L3 level and the skeletal muscle index (SMI) calculated by three independent raters. Results and limitations: A total of 285 patients were evaluated in the study, and the intraclass correlation for smooth muscle area was 0.97 (95% confidence interval: 0.94-0.98) between raters. The proportions of patients who met the definition of sarcopenia were 72% for men and 55% of women. Univariate linear regression analysis demonstrated that older age, male gender, and black race were highly significant predictors of SMI, whereas tumor stage and grade, chemotherapy, and surgical procedures were not predictors of SMI. Multivariate linear regression analysis demonstrated that modifiable lifestyle factors, including total physical activity (p = 0.830), strenuousness (high, moderate, and low) of physical activity (p = 0.874), individual nutritional components (daily calories, p = 0.739; fat, p = 0.259; carbohydrates, p = 0.983; and protein, p = 0.341), and HEI2010 diet quality (p = 0.822) were not associated with SMI. Conclusions: Lifestyle factors including diet quality and physical activity are not associated with SMI and therefore appear to have limited impact on sarcopenia. Sarcopenia may largely be affected by nonmodifiable risk factors. Patient summary: In this report, we aim to determine whether lifestyle factors such as diet and physical activity were the primary drivers of body composition changes and sarcopenia in bladder cancer survivors. We found that lifestyle factors including dietary habits, individual nutritional components, and physical activity do not demonstrate an association with skeletal muscle mass, and therefore may have limited impact on sarcopenia. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

METHODS: From April 1998 to October 2013, 16 cystectomies were performed on patients with a known history of bladder cancer treated with both chemotherapy and radiation therapy.Demographics, pathology, complications, and outcomes data were collected by chart review.The Kaplan-Meier method was used to calculate metastasis-free and overall survival.The log-rank test was used to compare survival curves.RESULTS: Cystectomy was done for locally recurrent disease in 15 patients and refractory hematuria in one patient.Median age was 75.5 years.Median BMI was 23.6 kg/m 2 .Median Charlson comorbidity index was 6. 10 of 16 cystectomies were started via a minimally invasive approach (8 robotic, 2 laparoscopic).One robotic and one laparoscopic cystectomy was converted to open.In patients who had lymphadenectomy, median nodal yield was 13 (IQR 6-30).11 patients had ileal conduit urinary diversion and 5 had continent diversion (4 Indiana pouch, 1 Studer neobladder).Median estimated blood loss was 500 mL and 9 patients required intraoperative blood transfusion.At 90 days after surgery, 5 patients developed a Clavien-Dindo complication grade !3 (1 mortality).Median hospital stay was 11 days.Five patients developed distant metastasis at a median of 13.3 months after surgery.Median overall survival was 31.4 months (95% CI 4.2-96.8).Patients who had cisplatin-based chemotherapy experienced longer overall survival than those who had non cisplatinbased chemotherapy (67.9 vs. 16.3 months, p[0.03).CONCLUSIONS: Although salvage cystectomy is a morbid surgery, a subset of patients experienced significant metastasis-free and overall survival.Robotic approaches and continent urinary diversions are feasible.Additional study is needed to guide management in this rarely studied patient population.