The prognostic utility of temporalis thickness measured on MRI scans in patients with intra-axial malignant brain tumours: a systematic review and meta-analysis

Abstract

Sarcopenia is associated with worsened outcomes in solid cancers [1].Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia[2]. Hence, this study aims to evaluate the relationship between TMTand outcome measures in patients with malignant intra-axial neoplasms.We searched Medline, Embase, Scopus, and Cochrane databases for relevantstudies. Event ratios with 95% confidence intervals (CI) were analysedusing the RevMan 5.4 software. Where meta-analysis was impossible, votecounting was used to determine the effect of TMT on outcomes. TheGRADE framework was used to determine the certainty of the evidence. Four outcomes were reported for three conditions across 17 studiesinvolving 4430 patients. Glioblastoma: thicker TMT was protective foroverall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progressionfree survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high),and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989)(GRADE high); there was no association with complications (HR 0.82;95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMTwas protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate);there was no association with PFS (GRADE low). Primary CNSlymphoma: TMT was protective for overall survival (HR 0.34; 95%CI 0.19–0.60) (GRADE moderate) and progression free survival (HR0.23; 95% CI 0.09–0.56) (GRADE high).Across various intracranial intra-axial malignancies, patients withthicker TMT have better survival outcomes and are less prone to discontinuingtreatment secondary to drug toxicity. TMT has the potential tobe a valuable prognostic tool for risk-benefit considerations in the managementof these patients.