Sarcopenia Determined by Skeletal Muscle Index Predicts Overall Survival, Disease-free Survival, and Postoperative Complications in Resectable Esophageal Cancer

Abstract

Background: Sarcopenia has been identified as a prognostic factor among certain types of cancer. In esophageal cancer, patients are at increased risk of malnutrition and sarcopenia, ultimately contributing to poor outcomes. A systematic review was conducted to determine whether sarcopenia, defined by the skeletal muscle index, is predictive of overall survival, disease-free survival, and postoperative complications in resectable esophageal cancer. Materials and Methods: A systematic search of MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines up until January 2021. The primary outcome was overall survival; secondary outcomes included disease-free survival, pulmonary complications, and anastomotic leak. Results: Twenty-one studies (4 prospective; 17 retrospective; 3966 patients) were included. Sarcopenia was present in 1940 (48.1%) patients and was associated with lower overall survival [hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.25-1.95; P < 0.00001; I 2 = 71%] and disease-free survival (HR: 1.73; 95% CI: 1.04-2.87; P = 0.03; I 2 = 51%). A decrease in skeletal muscle index, independent of sarcopenia status, was associated with lower overall survival (HR: 1.81; 95% CI: 1.20-2.73; P = 0.005; I 2 = 92%). Sarcopenia was associated with increased odds of pulmonary complications (odds ratio: 1.86; 95% CI: 1.29-2.66; P = 0.0008; I 2 = 41%) and increased odds of anastomotic leak (odds ratio: 1.46; 95% CI: 1.11-1.93; P = 0.008; I 2 = 0%). Conclusions: Sarcopenia is a predictor of overall survival, disease-free survival, and postoperative complications in patients with resectable esophageal cancer. Studies on the modifiability of sarcopenia in the preoperative period will help determine the utility of nutritional interventions.

Sarcopenia reduces overall survival in unresectable oesophageal cancer: a systematic review and meta‐analysis

“…Given that sarcopenia is classified at the staging CT scan in the majority of studies included in the meta‐analysis, the results suggest that the prognostic impact of sarcopenia is present throughout disease progression. This notion is corroborated by a recently published systematic review on sarcopenia in resectable oesophageal cancer 26 …”

“…This notion is corroborated by a recently published systematic review on sarcopenia in resectable oesophageal cancer. 26 …”

“…This notion is corroborated by a recently published systematic review on sarcopenia in resectable oesophageal cancer. 26 Limitations to our study include the heterogeneity among the included studies regarding the type of medical therapy received, endoscopic stenting, and definition of unresectable disease. Furthermore, squamous cell carcinoma was the predominant tumour histology of the included studies, account-ing for the vast majority of patients.…”

The prognostic value of sarcopenia in oesophageal cancer: A systematic review and meta‐analysis

“… 11 However, they only included 11 studies with 1520 patients, and the selected studies were dated till 2018. In addition, Uzair et al 12 had conducted a meta‐analysis focusing on sarcopenia determined by SMI. They reported that sarcopenia was associated with poor survival outcomes in EC patients who had undergone surgical therapy.…”

“…Deng et al conducted a meta‐analysis to detect sarcopenia effects on long‐term survival of patients with EC, 11 however, they only included 11 studies with 1520 patients, and the selected studies were dated up to 2018. In addition, Uzair et al 12 had conducted another meta‐analysis, including 21 studies published before 2020 about sarcopenia assessed solely by CT‐based body imaging and included patients who underwent surgery with curative intent. Therefore, with more up to date research, this study aimed to make a significant contribution to quantitatively summarize all the existing evidence and achieve a better understanding of the clinical significance of sarcopenia with regard to prognosis and postoperative complication prediction in patients with EC.…”