Abstract
Sarcopenia is defined as either low pre-operative muscle mass or low muscle density on abdominal CT imaging. It has been associated with worse short-term outcomes after surgery for colorectal liver metastases. This study aimed to evaluate whether sarcopenia also impacts long-term survival outcomes in these patients. A random-effects meta-analysis was conducted following the PRISMA guidelines. Overall survival (OS) and disease-free survival (DFS) outcomes were evaluated. Eleven studies were included, ten reporting on the impact of low muscle mass and four on low muscle density. Sample sizes ranged between 47 and 539 (2124 patients in total). Altogether, 897 (42%) patients were considered sarcopenic, although definitions varied between studies. Median follow-up was 21-74 months. Low muscle mass (hazard ration (HR) 1.35, 95%CI 1.08-1.68) and low muscle density (HR 1.97, 95%CI 1.07-3.62) were associated with impaired OS. Low muscle mass (pooled HR 1.17, 95%CI 0.94-1.46) and low muscle density (pooled HR 1.13, 95%CI 0.85-1.50) were not associated with impaired RFS. Sarcopenia is associated with poorer OS, but not RFS, in patients with CRLM. Additional studies with standardized sarcopenia definitions are needed to better assess the impact of sarcopenia in patients with CRLM.
Highlights
Colorectal cancer is the second cause of cancer mortality worldwide.[1]
In order to determine whether a sarcopenic state impairs long-term survival outcomes in patients undergoing local therapy with curative intent for colorectal liver metastasis (CRLM), this study aims to systematically assess and meta-analyze available literature evaluating sarcopenia in light of overall- and recurrence-free survival after local therapy for CRLM
Studies were considered eligible for inclusion when the impact of sarcopenia on overall survival (OS) or recurrence-free survival (RFS) in patients undergoing local therapy with curative intent for CRLM was evaluated
Summary
Colorectal cancer is the second cause of cancer mortality worldwide.[1]. Fifteen percent of colorectal cancer patients present with colorectal liver metastasis (CRLM) upon diagnosis, while another fifteen percent will develop metachronous CRLM.[2]. In order to assess the prognosis of patients with CRLM, numerous risk models have been proposed. These models mainly consist of oncological characteristics, such as the size and number of CRLM, the presence of extrahepatic disease, and the lymph node status of the primary tumour. Sarcopenia is defined as either low pre-operative muscle mass or low muscle density on abdominal CT imaging. It has been associated with worse short-term outcomes after surgery for colorectal liver metastases. This study aimed to evaluate whether sarcopenia impacts long-term survival outcomes in these patients.
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