Abstract
BackgroundThe 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.MethodsEmbase, 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.ResultsA 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).ConclusionThe 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.
Highlights
The incidence of gastrointestinal (GI) malignancy is almost 30% worldwide, with high cancer-related mortality [1, 2]
Literature selection A total of 2942 studies were found according to the search strategy
The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% confidence interval (CI) = 1.369–1.873, P < 0.001, I2 = 59.5%, random-effect model) and disease-free mortality (HR = 1.461, 95% CI = 1.297– 1.646, P < 0.001, I2 = 0%, fixed-effect model)
Summary
The incidence of gastrointestinal (GI) malignancy is almost 30% worldwide, with high cancer-related mortality [1, 2]. An epidemiological survey found that the incidence of muscle reduction in healthy elderly Chinese was 4.1–11.5%. The incidence of muscle reduction in patients with CRC is significantly higher than that in healthy people, reflecting that the tumor is one of the causes of sarcopenia [12]. Several studies have shown that muscle reduction is closely related to the incidence of postoperative complications and the overall survival of esophagus, gastrointestinal tract, hepatobiliary and pancreatic malignancies [13–16]. The impact of sarcopenia on the outcome of GI cancer patients remains controversial due to the heterogeneity of different studies, and negative results have been found in different populations [17, 18]. 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
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