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Meta-Analysis
. 2019 Dec 3;19(1):82.
doi: 10.1186/s40644-019-0270-0.

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

Huaiying Su  1 , Junxian Ruan  2 , Tianfeng Chen  3 , Enyi Lin  4 , Lijing Shi  5
Affiliations
Meta-Analysis

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

Huaiying Su et al. Cancer Imaging. .

Abstract

Background: The impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome.

Methods: Embase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI.

Results: A total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12-0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369-1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297-1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083-1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042-1.448, P = 0.014).

Conclusion: The prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.

Keywords: Gastrointestinal oncology; Nutrient; Operation; Sarcopenia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of included studies
Fig. 2
Fig. 2
The bubble plots and linear relationship between the prevalence of sarcopenia and the cut-offs for females under different criteria (A. cut-off from Iritani et al.; B. cut-off from Zhuang et al.; C. cut-off from Prado et al.; D. cut-off from Martin et al.)
Fig. 3
Fig. 3
The forest plot for assessing the impact of sarcopenia on long-term outcomes (a. overall survival; b. disease-free survival)
Fig. 4
Fig. 4
The forest plot in assessing the impact of sarcopenia on short-term outcomes (a. total complication; b. major complication)
See this image and copyright information in PMC

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