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Pre-treatment sarcopenic assessments as a prognostic factor for gynaecology cancer outcomes: systematic review and meta-analysis

Abstract

Introduction

Gynaecology cancers, including ovarian (OC), endometrial (EC), and cervical (CC), are prevalent with high mortality. Sarcopenia is found in 38.7% of cancer patients, adversely affecting prognosis. Computed tomography (CT) is performed routinely in oncology, yet CT assessments of sarcopenia are not commonly used to measure prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic potential of pre-treatment sarcopenia assessments on overall survival (OS) and progression free survival (PFS) in gynaecology cancer.

Methodology

Four electronic databases were systematically searched from 2000 to May 2020 in English: Ovid Medline, EMBASE, Web of Science, and CINAHL plus. Titles and abstracts were screened, eligible full-texts were reviewed, and data from included studies was extracted. Meta-analyses were conducted on homogenous survival data, heterogenous data were narratively reported.

Results

The initial search yielded 767 results; 27 studies were included in the systematic review (n = 4286), all published between 2015 and 2020. Meta-analysis of unadjusted results revealed a negative effect of pre-treatment sarcopenia on OS in OC (HR: 1.40, 1.20–1.64, p < 0.0001) (n = 10), EC (HR: 1.42, 0.97–2.10, p = 0.07) (n = 4) and CC (HR: 1.10, 0.93–1.31, p = 0.28) (n = 5), and a negative effect on PFS in OC (HR: 1.28, 1.11–1.46, p = 0.0005) (n = 8), EC (HR: 1.51, 1.03–2.20, p = 0.03) (n = 2) and CC (HR: 1.14, 0.85–1.53, p = 0.37) (n = 2). Longitudinal analysis indicated negative effects of muscle loss on survival. Overall, there was a high risk of bias.

Conclusion

Pre-treatment sarcopenia negatively affected survival in gynaecology cancers. Incorporating such assessments into cancer management may be beneficial. Heterogeneity in sarcopenia assessments makes data interpretation challenging. Further research in prospective studies is required.

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Fig. 1: Flow diagram depicting the selection process for the studies.
Fig. 2: Forest plot of univariable results for pre-treatment sarcopenia (using seven different sarcopenia assessments: SMI, SMD, PA, PV, PI, IMAT, SMA) and overall survival in ovarian cancer patients.
Fig. 3: Forest plot of univariable results for pre-treatment sarcopenia (using five sarcopenia assessments: SMI, SMD, PI, SMG, SMI + SMD) and overall survival in endometrial cancer patients.
Fig. 4: Forest plot of univariable results for pre-treatment sarcopenia (using five sarcopenia assessments: SMI, SMD, PI, PA, SMA) and overall survival in cervical cancer patients.
Fig. 5: Forest plot of univariable results for pre-treatment sarcopenia (using six sarcopenia assessments: SMI, SMD, PA, PV, IMAT, SMA) and progression free survival in ovarian cancer patients.
Fig. 6: Forest plot of univariable results for pre-treatment sarcopenia (using four sarcopenia assessments: SMI, SMD, PI, SMG) and progression free survival in endometrial cancer patients.
Fig. 7: Forest plot of univariable results for pre-treatment sarcopenia (using four sarcopenia assessments: SMI, PI, PA, SMA) and progression free survival in cervical cancer patients.

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Acknowledgements

ES would like to acknowledge her affiliation with the Division of Medicine, University College London, and Dr Marialena Trivella who provided invaluable support with the statistical analysis. No financial assistance was received.

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Contributions

ES led the review, was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening eligible studies, extracting and analysing data, conducting meta-analysis, deriving all tables and figures. MP supported the research process, made critical comments that helped in the interpretation of results, supported in writing sections of the report, and reviewed the final report. SDC provided expert clinical advice and reviewed the final report. KF reviewed the final report.

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Correspondence to E. H. Sutton.

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Sutton, E.H., Plyta, M., Fragkos, K. et al. Pre-treatment sarcopenic assessments as a prognostic factor for gynaecology cancer outcomes: systematic review and meta-analysis. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01085-7

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