Li Hang-Long, Au Philip Chun-Ming, 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
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, Hong Kong.
Osteoporos Sarcopenia. 2021 Mar;7(Suppl 1):S34-S38. doi: 10.1016/j.afos.2021.02.005. Epub 2021 Mar 19.
Sarcopenia has been an emerging theme in clinical oncology. Various definitions of sarcopenia have been proposed, but their prognostic performance have yet to be evaluated and compared. The aim of this meta-analysis is to comprehensively evaluate the performance of different cutoff definitions of sarcopenia in cancer mortality prognostication.
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 binary lean mass categorized according to clearly defined cutoffs, and with all-cause mortality as study outcome. Studies were stratified according to the cutoff(s) used in defining low lean mass. The cutoff-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of low lean mass on cancer mortality were pooled with a random-effects model and compared.
Altogether 81 studies that studied binary lean mass were included. The pooled HRs on cancer mortality using the 3 most used definitions were: 1.74 (95% CI, 1.46-2.07) using the definition proposed by International Consensus of Cancer Cachexia, 1.45 (95% CI, 1.21-1.75) using that by Martin, and 1.58 (95% CI, 1.35-1.84) using that by Prado. The associations between sarcopenia and cancer mortality using other definitions were all statistically significant, despite different estimates were observed.
The association of low lean mass with increased mortality was consistent across different definitions; this provides further evidence on the poorer survival in cancer patients with sarcopenia. However, further studies evaluating the performance of each definition are warranted.
肌肉减少症已成为临床肿瘤学中一个新出现的主题。人们提出了多种肌肉减少症的定义，但它们的预后性能尚未得到评估和比较。本荟萃分析的目的是全面评估肌肉减少症不同截断定义在癌症死亡率预后中的性能。
这是一项荟萃分析。通过对PubMed、Cochrane图书馆和Embase进行系统检索，获取了2017年12月20日前发表的关于瘦体重与死亡率的队列研究。纳入标准为报告根据明确界定的截断值进行二元瘦体重分类且以全因死亡率作为研究结局的队列研究。根据定义低瘦体重时使用的截断值对研究进行分层。采用随机效应模型汇总低瘦体重对癌症死亡率的截断值特异性风险比（HRs）和95%置信区间（CIs）并进行比较。
共纳入81项研究二元瘦体重的研究。使用3种最常用定义得出的癌症死亡率汇总HRs分别为：采用癌症恶病质国际共识提出的定义时为1.74（95%CI，1.46 - 2.07），采用Martin提出的定义时为1.45（95%CI，1.21 - 1.75），采用Prado提出的定义时为1.58（95%CI，1.35 - 1.84）。尽管观察到不同的估计值，但使用其他定义时肌肉减少症与癌症死亡率之间的关联均具有统计学意义。
不同定义下低瘦体重与死亡率增加之间的关联是一致的；这为肌肉减少症癌症患者生存较差提供了进一步证据。然而，有必要进一步开展研究评估每个定义的性能。
