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

Abstract

The loss of skeletal muscle mass and function is defined as sarcopenia, which might develop in elderly patients with cancers. It has been indicated as a potential negative factor in the survival of patients with malignant tumours. The aim of this systematic review and meta-analysis was to evaluate the associations between sarcopenia and survival outcomes or postoperative complications in patients with oesophageal cancer (EC). Web of Science, Embase, Medline, and Cochrane Library databases were searched until 10 May 2022, using keywords: sarcopenia, oesophageal cancer, and prognosis. Studies investigating the prognostic value of sarcopenia on EC survival were included. Forest plots and summary effect models were used to show the result of this meta-analysis. The quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS). A total of 1436 studies were identified from the initial search of four databases, and 41 studies were included for the final quantitative analysis. This meta-analysis revealed a significant association between sarcopenia and overall survival (OS) [hazard ratios (HR):1.68, 95% confidence interval (CI):1.54-1.83, P = 0.004, I 2 = 41.7%] or disease-free survival (DFS) 1.97 (HR: 1.97, 95% CI: 1.44-2.69, P = 0.007, I 2 = 61.9%) of EC patients. Subgroup analysis showed that sarcopenia remained a consistent negative predictor of survival when stratified by different treatment methods, populations, or sarcopenia measurements. Sarcopenia was also a risk factor for postoperative complications with a pooled odds ratio of 1.47 (95% CI: 1.21-1.77, P = 0.094, I 2 = 32.7%). The NOS scores of all included studies were ≥6, and the quality of the evidence was relatively high. The results from the study suggested that sarcopenia was significantly associated with both survival outcomes and postoperative complications in EC patients. Sarcopenia should be appropriately diagnosed and treated for improving short-term and long-term outcomes of patients with EC.

The effect of sarcopenia on erlotinib therapy in patients with metastatic lung adenocarcinoma

“…The progressive loss of muscle mass and consequent loss of strength result in decreased quality of life, physical disability, increased toxicity of the therapeutic drug, and increased mortality rates. Sarcopenia may occur in approximately 50% of all lung cancer cases and predicts a poor prognosis [11,[14][15][16]. However, this has not yet been demonstrated in patients with lung cancer receiving erlotinib therapy.…”

“…Sarcopenia is the main feature of cancer cachexia, which is common in patients with lung cancer and can predict a poor prognosis [ 14 ]. Cachexia involves various mediators derived from the cancer cells, which are associated with systemic inflammation.…”

“…Similarly, in our study, the median OS and PFS in all patients were 26.7 months and 13.6 months, respectively. In general, sarcopenia was detected in approximately half of the patients with lung cancer and might be a significant predictor for poor response to the treatment and worse survival rates [ 9 , 11 , 14 ].…”

“…The relationship between sarcopenia and treatment-related toxicity is unclear in patients with lung cancer [ 13 , 14 , 26 , 27 ]. The studies have found similar treatment-related toxicity status in patients with sarcopenic and non-sarcopenic lung cancer treated with gefitinib and afatinib [ 11 , 16 ].…”

The association between thoracic sarcopenia and survival is gender specific in early-stage lung cancer

“…Similarly, thoracic sarcopenia, or reduced thoracic muscle mass, has been associated with impaired respiratory status and has been found to be a prognostic factor in the outcomes of cardiothoracic surgeries ( 14 , 15 ). Although there have been multiple investigations into the association between sarcopenia and outcomes of patients with lung cancer, few have examined the implications of measuring sarcopenia at various vertebral levels ( 10 , 12 , 16 - 20 ). Since a majority of patients with early-stage lung cancer do not receive abdominal computed tomography (CT) imaging, it is important to understand the relationship between thoracic sarcopenia and outcomes in this population.…”