Different definition of sarcopenia and mortality in cancer: A meta-analysis

Abstract

Objectives: Sarcopenia has been an emerging theme in clinical oncology. Various definitions of sarcopenia have been proposed, but their prognostic performance have yet to be evaluated and compared. The aim of this meta-analysis is to comprehensively evaluate the performance of different cutoff definitions of sarcopenia in cancer mortality prognostication.

Methods: This is a meta-analysis. Cohort studies on lean mass and mortality published before December 20, 2017 were obtained by systematic search on PubMed, Cochrane Library, and Embase. Inclusion criteria were cohort studies reporting binary lean mass categorized according to clearly defined cutoffs, and with all-cause mortality as study outcome. Studies were stratified according to the cutoff(s) used in defining low lean mass. The cutoff-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of low lean mass on cancer mortality were pooled with a random-effects model and compared.

Results: Altogether 81 studies that studied binary lean mass were included. The pooled HRs on cancer mortality using the 3 most used definitions were: 1.74 (95% CI, 1.46-2.07) using the definition proposed by International Consensus of Cancer Cachexia, 1.45 (95% CI, 1.21-1.75) using that by Martin, and 1.58 (95% CI, 1.35-1.84) using that by Prado. The associations between sarcopenia and cancer mortality using other definitions were all statistically significant, despite different estimates were observed.

Conclusions: The association of low lean mass with increased mortality was consistent across different definitions; this provides further evidence on the poorer survival in cancer patients with sarcopenia. However, further studies evaluating the performance of each definition are warranted.

Keywords: Cancer; Lean mass; Meta-analysis; Mortality; Sarcopenia.

Fig. 1

Pooled hazard ratios of common definitions of low lean mass with all-cause mortality in persons with cancer. All low lean mass was based on L3 skeletal muscle index.

Fig. 2

Forest plot of the association of low lean mass with overall mortality using the definition proposed by International Consensus of Cancer Cachexia.

Fig. 3

Forest plot of the association of low lean mass with overall mortality using the definition proposed by Prado. All low lean mass was based on L3 skeletal muscle index.

Fig. 4

Forest plot of the association of low lean mass with overall mortality using the definition proposed by Martin.