Au Philip Chun-Ming, Li Hang-Long, Lee Grace Koon-Yee, Li Gloria Hoi-Yee, Chan Marcus, Cheung Bernard Man-Yung, Wong Ian Chi-Kei, Lee Victor Ho-Fun, Mok James, Yip Benjamin Hon-Kei, Cheng Kenneth King-Yip, Wu Chih-Hsing, Cheung Ching-Lung
Department of Pharmacology and Pharmacy, Hong Kong.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Osteoporos Sarcopenia. 2021 Mar;7(Suppl 1):S28-S33. doi: 10.1016/j.afos.2021.03.002. Epub 2021 Mar 30.
The aim of this meta-analysis is to comprehensively evaluate the effects of lean mass on all-cause mortality across different cancer types.
This is a meta-analysis. Cohort studies on lean mass and mortality published before December 20, 2017 were obtained by systematic search on PubMed, Cochrane Library, and Embase. Inclusion criteria were cohort studies reporting lean mass measurements by dual-energy X-ray absorptiometry, bioimpedance analysis or computed tomography, and with all-cause mortality as the study outcome. Exclusion criteria were studies using muscle mass surrogates, anthropometric measurement of muscle, rate of change in muscle mass, and sarcopenia defined by composite criteria. Hazard ratios (HRs) and 95% confidence intervals (CIs) of low/reduced lean mass on cancer mortality were pooled with a random-effects model. Subgroup analysis stratifying studies according to cancer type and measurement index was performed.
Altogether 100 studies evaluated the association between lean mass and cancer mortality. The overall pooled HR on cancer mortality was 1.41 (95% CI, 1.24 to 1.59) for every standard deviation decrease in lean mass and 1.69 (95% CI, 1.56 to 1.83) for patients with sarcopenia (binary cutoffs). Overall mortality was also significantly associated with sarcopenia in across various cancer types, except for hematopoietic, breast, ovarian and endometrial, and prostate cancer.
The robust association of decreased lean mass with increased mortality further justified the importance of developing clinical guidelines for managing sarcopenia in cancer patients. Public health initiatives aiming at promoting awareness of muscle health in susceptible individuals are urgently needed.
本荟萃分析旨在全面评估瘦体重对不同癌症类型全因死亡率的影响。
这是一项荟萃分析。通过对PubMed、Cochrane图书馆和Embase进行系统检索，获取2017年12月20日前发表的关于瘦体重与死亡率的队列研究。纳入标准为通过双能X线吸收法、生物电阻抗分析或计算机断层扫描报告瘦体重测量值且以全因死亡率作为研究结局的队列研究。排除标准为使用肌肉量替代指标、肌肉的人体测量、肌肉量变化率以及由综合标准定义的肌肉减少症的研究。采用随机效应模型汇总低/减少瘦体重对癌症死亡率的风险比（HRs）和95%置信区间（CIs）。根据癌症类型和测量指标进行分层的亚组分析。
共有100项研究评估了瘦体重与癌症死亡率之间的关联。瘦体重每降低一个标准差，癌症死亡率的总体合并HR为1.41（95%CI，1.24至1.59），肌肉减少症患者（二分法临界值）为1.69（95%CI，1.56至1.83）。除造血系统、乳腺、卵巢和子宫内膜癌以及前列腺癌外，在各种癌症类型中，总体死亡率也与肌肉减少症显著相关。
瘦体重降低与死亡率增加之间的有力关联进一步证明了制定癌症患者肌肉减少症管理临床指南的重要性。迫切需要开展公共卫生倡议，以提高易感个体对肌肉健康的认识。
