Evidence map›Paper›PMID 34342095›Full record

ArticleThe oncologist2021

Body Composition as an Independent Predictive and Prognostic Biomarker in Advanced Urothelial Carcinoma Patients Treated with Immune Checkpoint Inhibitors.

Dylan J Martini, Julie M Shabto, Subir Goyal, Yuan Liu, T Anders Olsen, Sean T Evans, Benjamin L Magod, Deepak Ravindranathan, Jacqueline T Brown, Lauren Yantorni and 12 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The oncologist, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
5.2field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 2 institutions in 1 country.

Dylan J MartiniWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.ORCID 0000-0002-0843-1222
Julie M ShabtoWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Subir GoyalDepartment of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia, USA.
Yuan LiuDepartment of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia, USA.
T Anders OlsenWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Sean T EvansWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Benjamin L MagodWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Deepak RavindranathanWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Jacqueline T BrownWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Lauren YantorniWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Greta Anne RusslerWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Sarah CaulfieldWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Jamie M GoldmanWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Bassel NazhaWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Shreyas Subhash JoshiDepartment of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Haydn T KissickDepartment of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Kenneth E OganDepartment of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Wayne B HarrisWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Omer KucukWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Bradley C CarthonWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Viraj A MasterDepartment of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Mehmet Asim BilenWinship Cancer Institute of Emory University, Atlanta, Georgia, USA.
Emory University · USNorthwestern University · US

Funding

Winship Cancer Institute Cancer Center Support GrantP30CA138292 · NCI · EMORY UNIVERSITY · PI Suresh S Ramalingam · 2009 to 2026
$47.5M
NCI NIH HHS P30 CA138292
6 · The paper itself

Abstract

backgroundSeveral immune checkpoint inhibitors (ICIs) are approved for the treatment of advanced urothelial carcinoma (UC). There are limited biomarkers for ICI-treated patients with UC. We investigated the association between body composition and clinical outcomes in ICI-treated UC patients. MATERIALS AND

methodsWe conducted a retrospective analysis of 70 ICI-treated patients with advanced UC at Winship Cancer Institute from 2015 to 2020. Baseline computed tomography images within 2 months of ICI initiation were collected at mid-L3 and muscle and fat compartments (subcutaneous, intermuscular, and visceral) were segmented using SliceOMatic v5.0 (TomoVision, Magog, Canada). A prognostic body composition risk score (high: 0-1, intermediate: 2-3, or low-risk: 4) was created based on the β coefficient from the multivariate Cox model (MVA) following best-subset variable selection. Our body composition risk score was skeletal muscle index (SMI) + 2 × attenuated skeletal muscle (SM) mean + visceral fat index (VFI). Concordance statistics (C-statistics) were used to quantify the discriminatory magnitude of the predictive model.

resultsMost patients (70%) were men and the majority received ICIs in the second- (46%) or third-line (21%) setting. High-risk patients had significantly shorter overall survival (OS; hazard ratio [HR], 6.72; p < .001), progression-free survival (HR, 5.82; p < .001), and lower chance of clinical benefit (odds ratio [OR], 0.02; p = .003) compared with the low-risk group in MVA. The C-statistics for our body composition risk group and myosteatosis analyses were higher than body mass index for all clinical outcomes.

conclusionBody composition variables such as SMI, SM mean, and VFI may be prognostic and predictive of clinical outcomes in ICI-treated patients with UC. Larger, prospective studies are warranted to validate this hypothesis-generating data. IMPLICATIONS FOR PRACTICE: This study developed a prognostic body composition risk scoring system using radiographic biomarkers for patients with bladder cancer treated with immunotherapy. The study found that the high-risk patients had significantly worse clinical outcomes. Notably, the study's model was better at predicting outcomes than body mass index. Importantly, these results suggest that radiographic measures of body composition should be considered for inclusion in updated prognostic models for patients with urothelial carcinoma treated with immunotherapy. These findings are useful for practicing oncologists in the academic or community setting, particularly given that baseline imaging is routine for patients starting on treatment with immunotherapy.

Indexed as

Carcinoma, Transitional CellUrinary Bladder NeoplasmsBody CompositionFemaleHumansImmune Checkpoint InhibitorsMalePrognosisRetrospective StudiesImmune Checkpoint InhibitorsAdiposityBiomarkersBody compositionImmune checkpoint inhibitorsMyosteatosisPrognostic modelSarcopeniaUrothelial carcinoma

Identifiers

PMID34342095
PMCPMC8649001
OpenAlexW3188534843

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.