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Meta-Analysis
. 2022 Apr;25(4):615-626.
doi: 10.1038/s41391-021-00442-0. Epub 2021 Aug 21.

Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis

Pedro Lopez  1   2 , Robert U Newton  3   4   5 , Dennis R Taaffe  3   4 , Favil Singh  3   4 , Laurien M Buffart  3   6 , Nigel Spry  3   4   7 , Colin Tang  3   4   8 , Fred Saad  9 , Daniel A Galvão  3   4
Affiliations
Meta-Analysis

Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis

Pedro Lopez et al. Prostate Cancer Prostatic Dis. 2022 Apr.

Abstract

Background: To systematically review and analyse the associations between fat and muscle mass measures with overall survival in men with prostate cancer.

Methods: A systematic search was conducted in CINAHL, Cochrane Library, EMBASE, PubMed, and Web of Science databases from inception to December 2020, while abstracts from the American Society of Clinical Oncology (ASCO), Clinical Oncology Society of Australia (COSA), and the American College of Sports Medicine (ACSM) conferences were searched from 2014 to 2020. Eligible articles examined the association of body composition measures, such as fat mass (e.g., fat mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT) and muscle mass measures, with overall survival in prostate cancer patients at any treatment stage. The primary endpoint was overall survival. Random-effect meta-analysis was conducted for studies reporting multivariable or univariable analysis assessing the associations of fat mass measures (i.e., fat mass, VAT, SAT, VAT/SAT) and muscle mass measures with overall survival.

Results: Sixteen cohort studies that comprised 4807 men with prostate cancer were included. Total adiposity (hazard ratio (HR) 0.98, 95% CI: 0.75-1.28, p = 0.888) and VAT (HR 1.03, 95% CI: 0.74-1.43, p = 0.873) were not significantly associated with overall survival, while higher subcutaneous adipose tissue levels were associated with higher survival (HR 0.68, 95% CI: 0.54-0.84, p = 0.001). Greater mortality risk was found in patients with localised (HR 1.91, 95% CI: 1.40-2.62, p < 0.001) and advanced disease (HR 1.43, 95% CI: 1.07-1.92, p = 0.020) presenting with low levels of muscle mass compared to those presenting with high levels.

Discussion: These results indicate that although overall adiposity should be cautiously interpreted in regards to survival, high muscle mass and SAT, and low VAT/SAT ratio values are associated with overall survival in men with prostate cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow chart.
Flow chart of study selection process.
Fig. 2
Fig. 2. Random-effects meta-analysis.
Association of low and high levels of VAT, SAT and VAT/SAT ratio (A, B) and muscle mass (C, D) with overall survival in men with prostate cancer. Analyses derived from multivariable and univariate models were presented in A, C and B, D, respectively. Higher VAT/SAT ratio indicates poorer overall survival. Overall effects analyses conducted with inverse variance random-effects meta-analysis. Squares represent study-specific estimates; diamonds represent pooled hazard ratios estimates of random-effects meta-analysis. *Study-specific estimate based on median values derived from skeletal muscle mass index and skeletal muscle volume indexes; FM fat mass, SAT subcutaneous adipose tissue, VAT visceral adipose tissue.
See this image and copyright information in PMC

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