Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment

Abstract

This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I²: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I² < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.

Keywords: cancer; disability; hospital-acquired infections; post-operative complications; prevalence; risk factor; sarcopenia; survival; toxicities.

Figure A1

Flaw chart of the meta-analysis.

Figure A2

Funnel plot of the prevalence of pre-therapeutic sarcopenia among cancer patients (p value for asymmetry [Peters’ test] < 0.0001). Gold points = studies; blue dash lines = common effect with 95% CI; red dash lines = random effect.

Figure A3

Pooled relative risk (RR) of the predictive value of pre-therapeutic sarcopenia on overall survival among cancer patients [14,15,16,17,18,23,24,25,26,28,30,33,34,36,37,39,42,43,47,48,49,50,51,52,55,56,58,61,65,67,70,72,75,77,79,80,81,83,89,91,93,94,96,98,100,101,102,103,104,107,108,112,113,114,115,116,117,119,125,130,132,133,135,136,144,146,147,148,149,150,153,155,159,161,162,163,165,167,168,169,170,171,174,181,184,189,191,193,194,195,196,197,198,200,209,210,211,214,224,229,230,232,234].

Figure A4

Pooled relative risk (RR) of the predictive value of pre-therapeutic sarcopenia on progression-free survival among cancer patients [15,17,19,23,25,31,35,36,42,46,50,62,63,72,77,81,98,102,112,116,122,130,153,159,184,191,197,214,229,233].

Figure A5

Pooled relative risk (RR) of the predictive value of pre-therapeutic sarcopenia on severe post-operative complications among cancer patients [18,26,49,51,54,55,56,57,58,59,70,71,72,76,77,84,85,86,103,104,111,119,123,125,126,127,129,131,138,143,150,155,157,158,162,164,169,170,175,177,179,184,187,188,190,191,192,199,202,203,205,206,207,209,212,213,214,216,217,220].

Figure A6

Pooled relative risk (RR) of the predictive value of pre-therapeutic sarcopenia on severe treatment-related toxicity and/or dose limiting toxicity among cancer patients [22,36,40,47,70,79,82,89,96,118,129,130,136,156,161,176,183,186,215,221,233].

Figure A7

Pooled relative risk (RR) of the predictive value of pre-therapeutic sarcopenia on nosocomial infections among cancer patients [57,64,76,84,95,111,123,146,151,152,168,177,179,182,190,192,199,206,207,210,225,235].

Figure 1

Non-parametric regression via smoothing splines for assessing the relationship between prevalence of pre-therapeutic sarcopenia and cut-off values of SMI (A,B), ASM (C,D), or PMI (E,F) in women and men with cancer, respectively.

Figure 2

Pooled mean differences (MD) of handgrip strength (A, kg) and gait speed (B, m/s) between sarcopenic and non-sarcopenic groups among cancer patients [26,51,58,111,138,145,169,177,179,187,206,216].