Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC, Australia.
Department of Nutrition and Dietetics, Monash Medical Centre, Monash Health, Clayton, VIC, Australia.
J Cachexia Sarcopenia Muscle. 2022 Apr;13(2):839-857. doi: 10.1002/jcsm.12928. Epub 2022 Feb 13.
Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health-related quality of life (HRQOL) is less established. This systematic review and meta-analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta-analysis to investigate cross-sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies (n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [n = 985 from seven studies, standardized mean difference -0.27, 95% confidence interval (CI) -0.40 to -0.14, P < 0.0001], and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardized mean difference -0.40, 95% CI -0.74 to -0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P > 0.05). Five studies examined the cross-sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non-linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.
骨骼肌质量低与癌症患者较差的发病率和死亡率结局相关，但它对健康相关生活质量（HRQOL）的影响证据尚不明确。本系统评价和荟萃分析旨在调查癌症成人骨骼肌质量与 HRQOL 之间的关系。从 2007 年 1 月 1 日至 2020 年 9 月 2 日，系统地检索了 5 个数据库（Ovid MEDLINE、Ovid 中的 Embase、CINAHL plus、Scopus 和 PsycInfo）。纳入了报告分析计算机断层扫描成像得出的骨骼肌（质量和/或放射密度）与癌症成人经过验证的 HRQOL 测量之间关联的研究。将将骨骼肌质量分类为类别变量（低或正常）的研究合并进行荟萃分析，以调查与 HRQOL 的横断面关联。报告骨骼肌为连续变量的研究进行定性综合。共有 14 项研究涉及 2776 名参与者符合纳入标准。在 10 项研究中，使用骨骼肌质量分类为低或正常来将参与者分为两组（n=1375）。在这 10 项研究中使用了 5 个不同的分类切点，其中 58%的参与者被归为肌肉量低。低肌肉量与较差的整体 HRQOL 评分相关[n=985，来自 7 项研究，标准化均数差-0.27，95%置信区间（CI）-0.40 至-0.14，P<0.0001]，且较差的身体功能域 HRQOL 评分（n=507，来自 5 项研究，标准化均数差-0.40，95%CI-0.74 至-0.05，P=0.02），但社交、角色、情感或认知功能域评分无差异（均 P>0.05）。有 5 项研究检查了 HRQOL 与骨骼肌质量作为连续变量的横断面关系，除非使用非线性分析，否则几乎没有证据表明存在关联。有 2 项研究调查了骨骼肌和 HRQOL 随时间纵向变化之间的关系，报告在多个 HRQOL 领域存在关联。在癌症成人中，低肌肉量可能与整体和身体功能 HRQOL 评分较低相关。这种关系的解释受到研究之间低肌肉量分类差异的限制。需要前瞻性、纵向研究来检查随着时间的推移骨骼肌质量和 HRQOL 之间的相互作用，并且应该提供数据，以便根据不同的切点进行重新分析。需要进一步研究阐明这些结果之间的因果途径。
