Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

Abstract

Purpose Osteopenia typically presents low bone mineral density (BMD) and has recently been reported as a prognostic factor in various cancers. However, the prognostic value of osteopenia in digestive tract cancers remains to be defined. We aimed to review the prognostic value of preoperative osteopenia in patients with digestive cancers. Methods Cohort studies evaluating the prognostic value of preoperative osteopenia in digestive cancers (colorectal, esophageal, hepatic, bile duct, and pancreatic cancer) were searched using electronic databases and trial registries. The exposure was defined as low BMD estimated by computed tomography at 11th thoracic vertebra, while comparator was normal BMD. The primary outcomes were overall survival and recurrence-free survival for osteopenia. Random effect meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. Results A total of 11 studies (2230 patients) were included. Osteopenia was an independent risk factor for overall survival (hazard ratio [HR] = 2.02, 95% CI = 1.47 to 2.78; I2 = 74%), along with sarcopenia. Osteopenia also predicted poor recurrence-free survival (HR = 1.96, 95% CI = 1.36 to 2.81; I2 = 85%). In subgroup analyses, osteopenia predicted prognosis in colorectal, esophageal, hepatic, and bile duct cancers, but not in pancreatic cancer. The certainty of the evidence was low due to inconsistency and publication bias. Conclusion Osteopenia may be independently associated with poor prognosis in patients with digestive tract cancer. Further studies are needed to establish the relevance of osteopenia in the operative prognosis of these patients.

Prognostic significance of preoperative osteopenia on outcomes after gastrectomy for gastric cancer

“…A review by Watanabe et al reported that low BMD in colorectal cancer, colorectal liver metastases, esophageal cancer, and extrahepatic cholangiocarcinoma was a significant risk factor for OS and DFS. 8 The same result was obtained in the current study; however, no prior studies have reported a prognostic association between osteopenia and GC; thus, these results are valuable.…”

“… 7 Some studies have demonstrated that preoperative osteopenia in patients with digestive tract cancers, such as pancreatic, colon, and esophageal cancers, predicts poor prognosis. 8 However, the effect of preoperative osteopenia on the prognosis of patients with GC remains unclear. This study aimed to clarify the impact of preoperative osteopenia on the outcomes of patients who underwent gastrectomy for GC compared with other preoperative systemic inflammatory response markers and sarcopenia.…”

“…However, computed tomography (CT)‐measured BMD by measuring the mean pixel density of the thoracic vertebral trabeculae on CT has recently been found to be correlated with DEXA 7 . Some studies have demonstrated that preoperative osteopenia in patients with digestive tract cancers, such as pancreatic, colon, and esophageal cancers, predicts poor prognosis 8 . However, the effect of preoperative osteopenia on the prognosis of patients with GC remains unclear.…”

The Prognostic Impact of Preoperative Osteopenia in Patients With Colorectal Cancer

“…8,10,11 The progressive decline in bone mineral density (BMD), resulting in bone loss, known as osteopenia/ osteoporosis, is another body composition index that has recently received attention as a prognostic factor in digestive cancers. 6,12,13 Bone loss in patients with cancers has been demonstrated even in the absence of bone metastases and is considered to reflect systemic inflammation, malnutrition, and sarcopenia. In fact, there are several reports showing the poor prognostic impact of osteopenia in hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, and esophageal cancer.…”

“…In fact, there are several reports showing the poor prognostic impact of osteopenia in hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, and esophageal cancer. 13–18 With regard to CRC, there are only a few reports with small cohort sizes. 12,13…”