Sarcopenia In Cancer Patients Research Articles

Evaluating sarcopenia in cancer patients: focus on the rectus femoris muscle.

Evaluating sarcopenia in cancer patients: focus on the rectus femoris muscle.

The sGCa Vericiguat Exhibit Cardioprotective and Anti-Sarcopenic Effects through NLRP-3 Pathways: Potential Benefits for Anthracycline-Treated Cancer Patients.

Anthracycline-induced cardiomyopathies and sarcopenia are frequently seen in cancer patients, affecting their overall survival and quality of life; therefore, new cardioprotective and anti-sarcopenic strategies are needed. Vericiguat is a new oral guanylate cyclase activator that reduces heart failure hospitalizations or cardiovascular death. This study highlighted the potential cardioprotective and anti-sarcopenic properties of vericiguat during anthracycline therapy. Human cardiomyocytes and primary skeletal muscle cells were exposed to doxorubicin (DOXO) with or without a pre-treatment with vericiguat. Mitochondrial cell viability, LDH, and Cytochrome C release were performed to study cytoprotective properties. Intracellular Ca++ content, TUNEL assay, cGMP, NLRP-3, Myd-88, and cytokine intracellular levels were quantified through colorimetric and selective ELISA methods. Vericiguat exerts significant cytoprotective and anti-apoptotic effects during exposure to doxorubicin. A drastic increase in cGMP expression and reduction in NLRP-3, MyD-88 levels were also seen in Vericiguat-DOXO groups vs. DOXO groups (p < 0.001) in both cardiomyocytes and human muscle cells. GCa vericiguat reduces cytokines and chemokines involved in heart failure and sarcopenia. The findings that emerged from this study could provide the rationale for further preclinical and clinical investigations aimed at reducing anthracycline cardiotoxicity and sarcopenia in cancer patients.

Diagnostic Value of Serum Creatinine and Cystatin-C-Based Indices and Ishii Score in Cancer-Related Sarcopenia.

Sarcopenia is a key factor affecting the prognosis of cancer patients; however, identifying patients at risk remains challenging. The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI) are new biomarkers for sarcopenia screening. The Ishii test score is an equation based on age, grip strength, and calf circumference for sarcopenia screening. However, their performances in advanced cancer patients have not been thoroughly studied. We aimed to evaluate and compare the accuracy of three screening tools in diagnosing cancer-related sarcopenia. A total of 215 cancer patients with a median age of 60.5 y were enrolled in this cross-sectional study. The Asian Working Group for Sarcopenia 2019 (AWGS2019) criteria were used as a standard. The diagnostic accuracies of the CCR, SI, and Ishii screening test were analyzed in terms of sensitivity, specificity, negative and positive predictive values, the Youden index, and the receiver operating characteristic (ROC) curve. According to the AWGS2019 criteria, the prevalence of sarcopenia and severe sarcopenia was 47.9% and 18.6%, respectively. The CCR, SI (positively), and Ishii scores (negatively) were correlated with muscle mass. Accordingly, sarcopenia was negatively correlated with CCR and SI, while it was significantly positively correlated with the Ishii score. In males, the AUCs of the CCR, SI, and Ishii scores were 0.743 (95%CI 0.65-0.836), 0.758 (95%CI 0.665-0.852), and 0.833 (95%CI 0.751-0.909), respectively. In females, the AUCs of the CCR, SI, and Ishii scores were 0.714 (95%CI 0.61-0.818), 0.737 (95%CI 0.635-0.839), and 0.849 (95%CI 0.775-0.932), respectively. The AUC of the Ishii score was significantly higher than that of the other screening tools (p < 0.001). The cut-off value of the optimal Ishii score was 102.3 (sensitivity: 93.2%, specificity: 59.1%) for males and 98.3 (sensitivity: 93.3%, specificity: 64.7%) for females. The CCR and SI based on serum CysC and creatinine had a remarkably similar overall diagnostic accuracy for sarcopenia in advanced cancer. Among the above three sarcopenia screening tools, the Ishii score chart seemed to have better predictive values of sarcopenia in cancer patients.

The Effectiveness of Sarcopenia Interventions for Cancer Patients Receiving Chemotherapy: A Systematic Review and Meta-analysis.

Among people with cancer undergoing chemotherapy, generalized loss of muscle mass, termed secondary sarcopenia , is associated with treatment toxicities and physical disability. This systematic review and meta-analysis aimed to provide an overview of current interventions for sarcopenia in cancer patients receiving chemotherapy and to assess potentially effective interventions. We searched PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and EMBASE for primary original research of exercise and nutrition interventions for sarcopenia published in English. The review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Standardized mean difference and 95% confidence interval (CI) were calculated as effect measures by applying the random-effects model. The 6 included studies showed a trend toward significantly increasing skeletal muscle mass after intervention (mean difference, 0.168; 95% CI, -0.015 to 0.352; P = .072), with no significant changes in lean body mass loss after intervention (mean difference, -0.014; 95% CI, -1.291 to 1.264; P = .983). Resistance exercise and combined exercise and nutrition intervention were more effective at preserving or increasing muscle mass. Early implementation of a resistance exercise intervention or a combined exercise and nutrition intervention is a promising strategy for avoiding muscle mass loss during chemotherapy. Additional evidence-based assessments of interventions for secondary sarcopenia are needed to identify the most effective approach. In clinical practice, oncology nurses should frequently assess cancer patients' muscle mass and when warranted should implement the most feasible early sarcopenia intervention to minimize the adverse outcomes of this condition.

Physical function, nutritional status, and quality of life before and after chemotherapy in patients with malignant lymphoma.

This study investigates the efficacy of and gender differences in exercise therapy in patients with malignant lymphoma undergoing chemotherapy. Twenty-six patients (13 men, 13 women) received physical therapy (based on the Borg Scale 13) during hospitalization. Physical function was measured using grip and knee extension strength, 6-minute walking distance, and body composition; nutritional status assessed via Mini Nutritional Assessment (MNA®); and serum albumin levels analyzed. Fatigue was evaluated using the Brief Fatigue Inventory, and health-related quality of life was assessed with the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). The analysis of all patients indicated that the right grip strength, skeletal muscle mass, skeletal muscle index, and leg muscle mass significantly decreased, whereas the serum albumin level, MNA® score, and scores of many items of the SF-36v2 significantly increased after chemotherapy. In a gender-specific analysis, only men showed significant declines in the skeletal muscle mass and skeletal muscle index, and improvement in the MNA® score after chemotherapy. In the SF-36v2, there were significant improvements in general health and physical component summary scores among men, and general health and mental component summary scores among women. Exercise therapy at a Borg Scale intensity of 13 may not prevent muscle mass decline in patients with malignant lymphoma, especially male patients. In addition, this study revealed that there is a gender difference in the effect of exercise therapy on quality of life. Thus, gender should be considered in exercise therapy for patients with malignant lymphoma.

Dual impact from coincide potential complications of cancer therapy and sarcopenia: a narrative review

Sarcopenia is a disorder of progressive loss of skeletal muscle mass and strength that is linked with multiple complications, decreased physical activity, lower quality of life and accelerated mortality rate. It is more common among cancer patients and identified with reduced tolerance by the toxic effects from cancer therapy, negative outcomes, lowered response and overall survival rate. This narrative review aims to demonstrate the dual impact from the co-occurrence of cancer therapy; chemotherapy, radiotherapy, immunotherapy, and sarcopenia alongside the potential complications from their coincide effects on cancer prognosis. By searching through data sets, all articles that focused on sarcopenia and cancer therapy were collected in the indexed journals between the years 2000 and 2021 that could provide findings for the potential complications from the coinciding effects of cancer therapy and sarcopenia in cancer patients receiving chemo-radio- and immunotherapy. Outcome measures were the rate of studies showing potential complications from the co-occurrence of cancer therapies and sarcopenia. A total of hundred-two cohort studies were enrolled. The majority were about chemotherapy and sarcopenia (45%). About 56.9% of the studies designed as retrospective analysis, and a high proportion were about chemotherapy and sarcopenia (21.6%). About 63.7% of the studies reported skeletal muscle index as the primary marker. Lower than half of the reviewed studies revealed a significant increase in the rate of sarcopenia (47%). The direct toxic effects of chemotherapy on skeletal muscle were reported in 13.7% of the studies. Studies that reported the impact of sarcopenia on a reduction in chemotherapy cycles were about 10.8%. About 11.8% and 14.7% of the studies showed lowered overall survival by the coinciding impact of chemotherapy/radiotherapy and sarcopenia, respectively. In conclusion, the evaluation of sarcopenia in cancer patients should be considered a primary part of oncological care in cancer patients as there are potential complications and poor survival from the co-occurrence of sarcopenia and different cancer therapies.

Relationship between the creatinine/cystatin C ratio and muscle mass measured by CT-scan in cancer patients.

Sarcopenia is observed in about 50% of cancer patients. Cancer-related sarcopenia negatively affects survival and is a predictive factor of anticancer drug toxicity. Sarcopenia diagnosis is challenging in routine care. We investigated whether plasma creatinine and cystatin C predict sarcopenia diagnosis in the specific population of cancer patients. Two common diagnostic criteria of cancer-related sarcopenia based on skeletal muscle mass±handgrip strength were separately applied as the "gold standard" sarcopenia definition. Four sarcopenia indexes based on creatinine and cystatin C values were evaluated: Creatinine/Cystatin C, Glomerular Filter rate (GFR) Cockroft-Gault/GFR CKD-EPI, GFR Cockroft-Gault/GFR Grubb and GFR Cockroft-Gault/GFR simple. The receiver operating characteristic (ROC) curves and the area under the ROC curves were applied to evaluate the sarcopenia diagnostic accuracy of the four different sarcopenia indexes. A total of 99 patients were included. Among them, 47.5% were overweight or obese. The ratio creatinine/cystatin C (ratio value at 0.8) more accurately predicts the diagnosis of sarcopenia in the entire population based on low skeletal muscle mass and low handgrip strength (sensitivity, specificity, accuracy and Youden index at 0.77, 0.57, 0.90, 0.34 respectively). The other evaluated ratios predict sarcopenia with a lower specificity in all conditions. In the overweight/obese group, the results are similar. The ratio creatinine/cystatin C (ratio value at 1) accurately predicts sarcopenia with a sensitivity, a specificity, an accuracy and a Youden index at 0.50, 0.86, 0.95, 0.36 respectively in overweight/obese population. The creatinine/cystatin C ratio is a useful and simple biomarker to predict sarcopenia in cancer patients. Moreover, this sarcopenia index also seems to be a strong sarcopenia diagnosis biomarker in overweight and obese cancer patients. Our results must be confirmed in a larger cohort.

Agreement between maximum and mean handgrip strength measurements in cancer patients.

Background and aimHandgrip strength (HGS) can be used to identify probable sarcopenia, by measuring maximum strength and/or through the average of three measurements. This study analyzed the agreement between maximum and mean HGS measurements in identifying probable sarcopenia in cancer patients.MethodsAdult individuals of both sexes diagnosed with malignant neoplasm were evaluated. HGS (kg/f) was measured in both hands and nutritional status defined by the Patient-Generated Subjective Global Assessment (PG-SGA). Bland-Altman, Intraclass Correlation Coefficient (ICC), and Cronbach’s Alpha tests were applied to assess the agreement between measurements.ResultsOne hundred forty-one patients aged 60.0 ± 14.2 years were evaluated. There was a predominance of elderly (57.4%), male (53.2%), and non-white (58.2%) individuals, with tumors located in the lower gastrointestinal tract (GIT) (36.9%) and with suspected or some degree of malnutrition (61.0%). For men, the Bland-Altman test showed a mean error of 1.37 (95% CI—1.03 to 3.80) for dominant HGS (DHGS) and 1.50 (95% CI—1.60 to 4.60) for non-dominant HGS (NDHGS), while for women the values were 1.34 (95% CI—0.27 to 2.95) and 1.14 (95% CI—1.10 to 3.39), respectively. The ICC showed excellent reproducibility (> 0.90) and the Cronbach’s Alpha was satisfactory (0.99).ConclusionDespite the satisfactory agreement observed between maximum and mean HGS values, in this study, individuals of both sexes with probable sarcopenia were better identified through mean values.

Older cancer patients receiving radiotherapy: a systematic review for the role of sarcopenia in treatment outcomes.

Previous studies have evaluated the prognostic effects of sarcopenia in cancer patients receiving various treatments, including chemotherapy and surgery, but few studies have focused on radiotherapy (RT). We aimed to investigate the prevalence of sarcopenia and the relationship between sarcopenia and outcomes in older cancer patients who underwent RT without chemotherapy. A systematic review of the literature was conducted in Pubmed/Medline and Cochrane databases in September 2021. We used the search terms and medical subject heading terms "sarcopenia," "low muscle mass (LMM)," "low muscle strength," "LMM and low muscle strength," "LMM and low muscle strength and low physical performance," and "RT." Outcomes were overall survival (OS), progression-free survival, non-cancer death, cancer death, disease-specific survival, local failure-free survival, distant failure-free survival, and RT-related toxicities. Among 460 studies, 8 studies were eligible for inclusion. The prevalence of sarcopenia was between 42.8% and 72%. Sarcopenia was not associated with OS or OS at 3years in seven studies in which it was defined as the presence of LMM, while it was related in one study, in which it was defined as the concomitant presence of LMM and muscle strength/function. There was heterogeneity between the studies because there was diversity in their inclusion criteria, definition and assessment methods used for detection of sarcopenia, considered cutoffs for low muscle mass and strength, cross-sectional locations on imaging to assess muscle mass and included covariates. The discrepancy in the results of the studies may also result from the variations in diagnoses, sample sizes, and treatment modalities. The low number of included studies and a small number of patients in each study limited generalizability. Sarcopenia may be a prognostic factor, especially in OS when low muscle strength/function is integrated into its definition. We suggest that clinicians focus on muscle strength/function while considering sarcopenia and its association with cancer and RT-related outcomes.

63P Obesity and sarcopenia as biomarkers for immunotherapy outcomes: A systematic review and meta-analysis

The role of overweight/obesity (ow/ob) and sarcopenia in cancer patients treated with immune checkpoint inhibitors (ICIs) continues to be debated. Therefore, we performed a systematic review and meta-analysis of published articles evaluating the effects of ow/ob and sarcopenia on survival and immune-related adverse events (irAEs).

The role of sarcopenia in the pancreatic adenocarcinoma.

Pancreaticoduodenectomy is still associated with prolonged hospitalization and with a lot of complications. For these reasons, it is fundamental to improve strategies for preoperative risk stratification, and sarcopenia is one of the new identified markers of frailty. The purpose of our study was to retrospectively detect sarcopenia in patients undergoing pancreaticoduodenectomy and evaluate its importance as a preoperative marker. We retrospectively identified a total amount of 76 consecutive patients who underwent pancreaticoduodenectomy for pancreatic head adenocarcinoma. Patients' and tumor's characteristics were recorded retrospectively. It appears that sarcopenia might be a useful preoperative prognostic factor for patients undergoing PD for PA. We found that Recurrence Free Survival may be influenced by presence or absence of preoperative sarcopenia, and we can confirm that in sarcopenic patients the average hospital stay is 20% longer than in non sarcopenic ones. Sarcopenia has a central role because it is a very common condition found in pancreatic cancer patients; there is growing evidence showing that it is associated with worse surgical outcomes. We can state that evaluating sarcopenia in cancer patients could improve the postoperative outcomes, overall survival rates and, nevertheless, the recurrence free survival ones.

Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.

Sarcopenia and mortality in cancer: A meta-analysis

ObjectivesThe aim of this meta-analysis is to comprehensively evaluate the effects of lean mass on all-cause mortality across different cancer types. MethodsThis is a meta-analysis. Cohort studies on lean mass and mortality published before December 20, 2017 were obtained by systematic search on PubMed, Cochrane Library, and Embase. Inclusion criteria were cohort studies reporting lean mass measurements by dual-energy X-ray absorptiometry, bioimpedance analysis or computed tomography, and with all-cause mortality as the study outcome. Exclusion criteria were studies using muscle mass surrogates, anthropometric measurement of muscle, rate of change in muscle mass, and sarcopenia defined by composite criteria. Hazard ratios (HRs) and 95% confidence intervals (CIs) of low/reduced lean mass on cancer mortality were pooled with a random-effects model. Subgroup analysis stratifying studies according to cancer type and measurement index was performed. ResultsAltogether 100 studies evaluated the association between lean mass and cancer mortality. The overall pooled HR on cancer mortality was 1.41 (95% CI, 1.24 to 1.59) for every standard deviation decrease in lean mass and 1.69 (95% CI, 1.56 to 1.83) for patients with sarcopenia (binary cutoffs). Overall mortality was also significantly associated with sarcopenia in across various cancer types, except for hematopoietic, breast, ovarian and endometrial, and prostate cancer. ConclusionsThe robust association of decreased lean mass with increased mortality further justified the importance of developing clinical guidelines for managing sarcopenia in cancer patients. Public health initiatives aiming at promoting awareness of muscle health in susceptible individuals are urgently needed.

Psoas muscle depletion during preoperative chemotherapy for advanced gastric cancer has a negative impact on long-term outcomes after gastrectomy.

AimThe significance of sarcopenia in cancers has been widely recognized. However, few studies have focused on chronological changes in sarcopenia in cancer patients. This study aimed to clarify the clinical significance of changes in the psoas muscle area before and after preoperative chemotherapy.MethodsThis study included 39 patients who underwent gastrectomy followed by preoperative chemotherapy for advanced gastric cancer between January 2010 and December 2016 in our hospital. The psoas muscle area was measured at the umbilical level before and after chemotherapy, and the relationship between its chronological changes and the long‐term prognosis was examined.ResultsPatients were classified into two groups according to changes in the psoas muscle area before and after preoperative chemotherapy: remarkable muscle depletion and normal groups. No significant differences were observed in clinicopathological factors. Notably, the remarkable muscle depletion group included significantly more male patients (P = .018) and showed a high weight loss rate (P < .001). Although no significant difference was observed in the recurrence‐free survival between the two groups (P = .484), overall survival was significantly worse in the remarkable muscle depletion group (P < .001). Multivariate analysis for prognosis revealed that pathological stage III or higher (P = .022) and decreased psoas muscle area (P = .038) were independent prognostic factors.ConclusionsThe present findings suggest that psoas muscle depletion during preoperative chemotherapy is a prognostic factor for poor long‐term outcomes in patients who underwent gastrectomy followed by preoperative chemotherapy for advanced gastric cancer.

Métodos para avaliação da sarcopenia em pacientes hospitalizados com câncer do trato gastrointestinal

Introduction: Sarcopenia is characterized by the association of loss of lean mass and functionality, and in cancer patients it is a frequent situation. Thus, the study aims to assess the presence of sarcopenia in hospitalized patients with cancer of the gastrointestinal tract using alternative assessments to analyse the patient’s strength and functionality. Methods: To assess sarcopenia in cancer patients, the thickness of the adductor pollicis muscle (APM), dynamometry to assess handgrip strength and the Barthel Scale to analyse functionality were collected, associating APM and dynamometer and MAP. with Barthel scale in cancer patients. Results: Twenty patients participated in the study, with moderately malnourished patients showing greater strength in the dynamometer in relation to the well-nourished ones and that obese individuals had greater APM in relation to other nutritional states. Regarding functionality, most patients 80% were classified as independent. Patients with esophageal cancer had MAP inferior to the other locations of the body evaluated, but compared with the dynamometer they presented better results. Conclusions: There was no high prevalence of sarcopenia among patients with cancer of the gastrointestinal tract using the methods used APM, dynamometer and Barthel Scale.

The need to reappraise the definition of sarcopenia in cancer patients

Rationale: In cancer patients, sarcopenia has been independently associated with worse outcome but it has been diagnosed exclusively on the presence of reduced skeletal muscle mass (SMM). However, based on consensus criteria for old adults it is defined by the co-existence of low muscle strength and reduced SMM. Particularly, low muscle strength has been pointed out as a key characteristic of sarcopenia. The prognostic significance of muscle function in cancer patients has been scantily investigated.

Sarcopenia in aging, obesity, and cancer.

Sarcopenia, defined as loss of muscle mass, strength and physical performance, is a hallmark of aging and is invariably associated with perturbation of amino acid metabolism, increased muscle protein catabolism relative to anabolism, and loss of muscle fibers. Sarcopenia may be associated with general loss of body mass, or it may also occur along with obesity [sarcopenic obesity (SO)]. Although sarcopenia is associated with multiple comorbidities in older adults, its effects may even be more severe in patients with malignant disease where it has been shown to contribute to poor surgical outcomes, increased chemotherapy toxicity associated with both cytotoxic and targeted agents, as well as adversely impacting survival. While development of sarcopenia is a common age-related phenomenon, the associated catabolic processes appear to be promoted by physical inactivity, inadequate nutrition, and systemic low-grade inflammation, as well as intrinsic muscle and molecular changes, including mitochondrial dysfunction and impaired muscle stem cell regenerative capacity. Increased physical activity and adequate protein intake can reduce incidence and severity of sarcopenia in cancer patients, but many older cancer patients do not meet physical activity and nutrition recommendations, and cancer treatment can make it more difficult to make favorable lifestyle changes. Sarcopenia is discussed in terms of its adverse clinical consequences in older subjects and particularly, in older patients with cancer. Contributions of lifestyle, molecular, and cellular factors are likewise reviewed with suggestions for interventions to improve sarcopenia and its comorbid sequalae.

Epidemiology of cancer‐related weight loss and sarcopenia in the UK and Ireland: incidence, prevalence, and clinical impact

AbstractBackgroundWeight loss (WL) and sarcopenia are associated with negative oncological outcomes including poor treatment tolerance, decreased quality of life, and reduced survival. The number of patients affected by sarcopenia and WL in Ireland and the UK is unknown.MethodsA systematic review was undertaken to determine median rate of WL &gt; 5% and computed tomography‐diagnosed sarcopenia in oncology populations. Gaps in the literature were supplemented using local data, collected as part of a 5 year prospective study. Rates of WL and sarcopenia in the population were extrapolated from these data based on incidence and prevalence of each cancer as per national cancer registries.ResultsWe estimated that across Ireland and the UK, 128 892 cancer patients (34%) are affected by WL &gt; 5% annually (121 641 UK; 7251 Ireland) and there are 133 707 annual cases of sarcopenia in cancer patients (35%) (126 265 UK; 7442 Ireland). Furthermore, we estimate that there are 716 124 and 771 589 cancer survivors with history of WL &gt; 5% or sarcopenia, respectively.ConclusionsLarge numbers of patients are affected by cancer‐related malnutrition. Given the impact of malnutrition on oncological outcomes and long‐term frailty, there is an urgent need to improve access to cancer nutrition care.

Radiologically Defined Sarcopenia Affects Survival in Head and Neck Cancer: A Meta-Analysis.

To determine whether radiologically defined sarcopenia at the C3 or L3 level as measured by computed tomography or magnetic resonance imaging is prognostic of overall survival (OS) in head and neck cancers (HNCs). Literature searches of PubMed, Embase, and Scopus were conducted on July 12, 2019, to include articles written in the English language with no constraints on publication date. To be included in the analysis, articles had to report the prognostic impact of skeletal muscle mass measured radiologically at the C3 or L3 vertebral level in HNC patients; hazard ratios (HRs) for OS; 95% confidence intervals (CIs); be from a clinical trial, cohort, or case-control study; and have English full-text availability. Articles were reviewed in consensus by two reviewers, with disagreements reviewed by a third reviewer. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology Checklist guidelines were used for reporting. Study quality assessment was performed using Quality In Prognosis Studies tool. The random-effects DerSimonian and Laird method was used for meta-analysis. Ten articles, nine retrospective and one prospective, were included in this meta-analysis (n = 2,181 patients). Significant differences were found in OS for HNC patients with sarcopenia (HR = 1.98; 95% CI: 1.64-2.39; P < .00001). No heterogeneity was detected in either the overall or subgroup analyses. Radiologically defined sarcopenia is a negative predictor of OS in patients with HNC. Early detection of sarcopenia in cancer patients may help guide nutritional and adjuvant support to improve treatment outcomes. NA Laryngoscope, 131:333-341, 2021.

The Relationship Between Sarcopenia and Cancer Chemotherapys

As an independent disease, characterized by progressive and generalized loss of skeletal muscle mass, quality and strength, Sarcopenia has become a research hotspot in recent years, and its position in cancer patients has been increasingly valued by clinicians. Clarifying the relationship between Sarcopenia and chemotherapeutics in the treatment of cancer patients will help to formulate interventions for Sarcopenia to improve the quality of life and prolong survival period of cancer patients. In order to understand the relationship between Sarcopenia and cancer chemotherapy, we review from the following aspects. How is Sarcopenia diagnosed in cancer patients? How to evaluate Sarcopenia in cancer patients? What is the incidence of Sarcopenia in cancer patients? What is the relationship between the changes in body composition and the dose of chemotherapy in cancer patients? Whether there is a relationship between Sarcopenia and chemotherapy-related toxicity in cancer patients? Its role in leading to chemotherapy toxicity and its effect on the prognosis and survival in cancer patients. Whether chemotherapeutic drugs have an effect on the development of Sarcopenia in cancer patients, or whether certain types of chemotherapy drugs will affect Sarcopenia? Finally, the review also aims to describe interventions for Sarcopenia and their impact on the outcome of treatment for cancer patients.