Sarcopenic Obesity and its Prognostic Impact on Urological Cancers: A Systematic Review

Abstract

Purpose: Sarcopenia, an age-related loss of muscle mass and function, may predict adverse outcomes for patients with urological cancers. However, the clinical implications and significance of sarcopenic obesity are not well understood. We systematically reviewed data on the prevalence and prognostic impact of sarcopenic obesity for patients with renal cell carcinoma, urothelial carcinoma and prostate cancer undergoing treatment. Materials and Methods: We searched EMBASEÒ, PubMedÒ/MEDLINEÒ and ScopusÒ for relevant original articles and abstracts published between January 2010 and February 2021. Primary outcomes were overall survival (OS), cancerspecific survival (CSS) and progression-free survival. The secondary outcome was the prevalence of sarcopenic obesity. Results: A total of 15 studies comprising 3,866 patients were included. Of the 10 studies that evaluated survival outcomes, the association between sarcopenic obesity and survival was mixed. One of 10 studies showed a significant association of sarcopenic obesity with OS (HR 0.7, 95% CI 0.51e0.98; p[0.04). One additional study showed reported a trend for shorter OS (p[0.05) associated with sarcopenic obesity. Others reported that it is an adverse prognostic factor for CSS (HR 5.0, 95% CI 1.4À16.7; p[0.01). All other studies did not demonstrate that sarcopenic obesity was of prognostic relevance with regard to OS, CSS and progression-free survival. Overall, its mean prevalence was 27% (range 11e63). Conclusions: There is considerable heterogeneity in methods used to define sarcopenic obesity in the literature, and current data are limited. Future studies

The role of sarcopenia in treatment-related outcomes in patients with renal cell carcinoma: A systematic review and meta-analysis

“…Therefore, some scholars adjust the measurement of skeletal muscle from fat composition. Mintziras [ 34 , 35 ] believes that this sarcopenia obesity (SO) reflects a worse physical condition than sarcopenia. With the continuous increase of obesity rate, this adjustment may be more accurate and appropriate, which is consistent with our results.…”

Prognostic value of the modified advanced lung cancer inflammation index in overweight or obese patients with lung cancer: Results from a multicenter study

“…However, low muscle mass is also an important component of malnutrition. Increasing number of studies have found that sarcopenic obesity is associated with a poor prognosis in patients 24–28 . Therefore, the assessment of muscle mass is of great value in identifying malnutrition in obese patients.…”

“…Increasing number of studies have found that sarcopenic obesity is associated with a poor prognosis in patients. [24][25][26][27][28] Therefore, the assessment of muscle mass is of great value in identifying malnutrition in obese patients. mALI, which integrates muscle mass, nutrition, and inflammation parameters, is a promising indicator for further assessment of malnutrition and prognosis in overweight or obese LC patients.…”

Prostate cancer treatment with exercise medicine

“…It is well established that muscle and adipose tissue both have endocrine function influencing the inflammatory and metabolic status of the body in somewhat of a yin and yang relationship 6 . Patients with prostate cancer who have high fat mass levels exhibit much poorer prognosis, including risk of mortality; 7 however, the evidence around high fat and low muscle ( sarcopenic obesity) is somewhat inconclusive at this stage and requires more high‐quality research 8 . Regardless, both obesity and sarcopenic obesity greatly increase risk of other chronic diseases such as cardiovascular and metabolic disorders and should be addressed as a priority for exercise prescription in these patients.…”

“…6 Patients with prostate cancer who have high fat mass levels exhibit much poorer prognosis, including risk of mortality; 7 however, the evidence around high fat and low muscle (sarcopenic obesity) is somewhat inconclusive at this stage and requires more high-quality research. 8 Regardless, both obesity and sarcopenic obesity greatly increase risk of other chronic diseases such as cardiovascular and metabolic disorders and should be addressed as a priority for exercise prescription in these patients. Exercise alone is not very effective for inducing fat loss.…”