The assessment and impact of sarcopenia in lung cancer: a systematic literature review

Abstract

ObjectivesThere is growing awareness of the relationship between sarcopenia (loss of muscle mass and function), and outcomes in cancer, making it a potential target for future therapies. In order to inform future research and practice, we undertook a systematic review of factors associated with loss of muscle mass, and the relationship between muscle function and muscle mass in lung cancer, a common condition associated with poor outcomes.DesignWe conducted a computerised systematic literature search on five databases. Studies were included if they explored muscle mass as an outcome measure in patients with lung cancer, and were published in English.SettingSecondary care.ParticipantsPatients with lung cancer.Primary outcomeFactors associated with loss of muscle mass and muscle function, or sarcopenia, and the clinical impact thereof in patients with lung cancer.ResultsWe reviewed 5726 citations, and 35 articles were selected for analysis. Sarcopenia, as defined by reduced muscle mass alone, was found to be very prevalent in patients with lung cancer, regardless of body mass index, and where present was associated with poorer functional status and overall survival. There were diverse studies exploring molecular and metabolic factors in the development of loss of muscle mass; however, the precise mechanisms that contribute to sarcopenia and cachexia remain uncertain. The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results. There are very limited data on the correlation between degree of sarcopenia and muscle function, which has a non-linear relationship in older non-cancer populations.ConclusionsLoss of muscle mass is a significant contributor to morbidity in patients with lung cancer. Loss of muscle mass and function may predate clinically overt cachexia, underlining the importance of evaluating sarcopenia, rather than weight loss alone. Understanding this relationship and its associated factors will provide opportunities for focused intervention to improve clinical outcomes.

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

“…Several studies have reported that sarcopenia was associated with poor prognosis in lung cancer, but most of these included patients with advanced stage cancer . According to a rare report about sarcopenia in stage I NSCLC patients, sarcopenia was associated with poor prognosis in men but was not associated with postoperative complications .…”

A comparative study of software programmes for cross‐sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients

“…In multiple surgical populations, such as vascular, gastrointestinal, urological, gynaecological, and transplantation surgery, the association between low skeletal muscle mass and an increased risk of post operative complications, recurrent disease, or impaired survival has been shown. Low skeletal muscle mass is also related to discharge destination in elderly trauma patients, associated with an increased risk of dose‐limiting chemotherapy toxicity and with morbidity and mortality in various oncologic populations, such as lung cancer and melanoma patients . Furthermore, CT‐assessed visceral obesity is associated with worse short‐term and long‐term outcome in distinct patient populations undergoing surgery .…”

“…Low skeletal muscle mass is also related to discharge destination in elderly Software programmes for body composition measurements on CT trauma patients, 45 associated with an increased risk of doselimiting chemotherapy toxicity 17,24,25,46 and with morbidity and mortality in various oncologic populations, such as lung cancer and melanoma patients. 47,48 Furthermore, CT-assessed visceral obesity is associated with worse short-term and long-term outcome in distinct patient populations undergoing surgery. 30 Various software programmes have been used to measure body composition in these studies.…”

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

“…It is associated with numerous negative outcomes, including an impaired stress response, frailty, functional impairment, lower quality of life and decreased overall survival [34][35][36][37]. As such, acute sarcopenia, could then explain, at least in part, the dramatic drop in quality of life experienced by even the most functional patients at baseline who undergo CTRT for HNSCC [38].…”