Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026
DAG-informed analysis of muscle characteristics and overall survival in patients receiving radical treatment for bladder cancer.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Vickers Alexander J, McSweeney Donal M, Choudhury Ananya, Weaver Jamie, Jones Craig, Dyer James, Price Gareth, McWilliam Alan
Аннотация
BACKGROUND: Reduced skeletal muscle (SM) quantity and quality may influence outcomes in bladder cancer, but most studies are associative and vulnerable to confounding and inconsistent covariate adjustment. We applied a directed acyclic graph (DAG)-informed framework to evaluate associations between computed tomography-derived SM characteristics and overall survival (OS) in patients receiving curative-intent radiotherapy-based bladder preservation or radical cystectomy.
METHODS: This retrospective two-centre cohort study included patients treated between 2014 and 2024. Computed tomography imaging closest to definitive local therapy was analysed using an automated segmentation pipeline to quantify SM quantity, expressed as skeletal muscle index (SMI), and quality, expressed as intramuscular adipose tissue ratio (IMATR). A DAG was used to prespecify the adjustment strategy, and Cox models were fitted separately within radiotherapy and surgical cohorts.
RESULTS: The final cohorts comprised 353 radiotherapy-treated and 117 surgically treated patients. In the radiotherapy cohort, higher SMI was associated with improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.007), while higher IMATR was associated with worse OS (HR 1.24, 95% CI 1.04-1.48, p = 0.014). In the smaller surgical cohort, point estimates were directionally discordant with the radiotherapy findings and imprecise: SMI HR 1.35 (95% CI 0.99-1.85, p = 0.057) and IMATR HR 0.86 (95% CI 0.62-1.21, p = 0.39).
CONCLUSIONS: In this DAG-informed analysis, higher SMI and lower IMATR were associated with improved OS in radiotherapy-treated patients. Surgical estimates were imprecise and should be considered exploratory. These findings are hypothesis-generating and support further evaluation of CT-derived muscle characteristics as prognostic markers within radiotherapy-treated populations but cannot yet establish a differential benefit for radiotherapy vs cystectomy.
METHODS: This retrospective two-centre cohort study included patients treated between 2014 and 2024. Computed tomography imaging closest to definitive local therapy was analysed using an automated segmentation pipeline to quantify SM quantity, expressed as skeletal muscle index (SMI), and quality, expressed as intramuscular adipose tissue ratio (IMATR). A DAG was used to prespecify the adjustment strategy, and Cox models were fitted separately within radiotherapy and surgical cohorts.
RESULTS: The final cohorts comprised 353 radiotherapy-treated and 117 surgically treated patients. In the radiotherapy cohort, higher SMI was associated with improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.007), while higher IMATR was associated with worse OS (HR 1.24, 95% CI 1.04-1.48, p = 0.014). In the smaller surgical cohort, point estimates were directionally discordant with the radiotherapy findings and imprecise: SMI HR 1.35 (95% CI 0.99-1.85, p = 0.057) and IMATR HR 0.86 (95% CI 0.62-1.21, p = 0.39).
CONCLUSIONS: In this DAG-informed analysis, higher SMI and lower IMATR were associated with improved OS in radiotherapy-treated patients. Surgical estimates were imprecise and should be considered exploratory. These findings are hypothesis-generating and support further evaluation of CT-derived muscle characteristics as prognostic markers within radiotherapy-treated populations but cannot yet establish a differential benefit for radiotherapy vs cystectomy.