Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China.
PLoS One. 2022 Jun 24;17(6):e0270332. doi: 10.1371/journal.pone.0270332. eCollection 2022.
Sarcopenia is usually characterized by the loss of skeletal muscle mass and impaired muscle function which is commonly seen in the elderly. It has been found to be associated with poorer prognoses in many types of cancer. Computed tomography (CT) scan is frequently used to assess skeletal muscle mass and further calculate skeletal muscle index (SMI) at the third lumbar vertebra level (L3), which is used to define sarcopenia. The purpose of this meta-analysis was to assess the prognostic value of sarcopenia for overall survival (OS) in patients with rectal cancer.
We performed a systematic search to find relevant studies published up to 14 January 2021 in PubMed, Embase, Web of science and Scopus. In our meta-analysis, studies comparing OS in rectal cancer patients with sarcopenia versus those without were included. Quality assessment for included studies was evaluated according to the Quality in Prognosis Studies (QUIPS) tool. We directly extracted hazard ratios (HRs) with 95% confidence intervals (CIs) in both univariate and multivariate analyses from each study. The Cochrane Collaboration's Review Manager 5.4 software was applied to analyze data. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines and website GRADEpro.
Finally, a total of 7 studies involving 2377 patients were included. The pooled HRs were 2.10 (95% CI 1.33-3.32, P = 0.001) and 2.37 (95% CI 1.13-4.98, P = 0.02) using random-effects models in univariate and multivariate analyses, respectively. The results showed a significant association between sarcopenia and OS in patients with rectal cancer. The quality of the evidence for OS was moderate for both univariate and multivariate analyses.
CT-defined sarcopenia is an independent predictor for worse OS in patients with rectal cancer. Future studies with a more stringent definition of sarcopenia are required to further confirm our findings.
肌少症通常表现为骨骼肌质量的丧失和肌肉功能受损，这在老年人中很常见。它已被发现与许多类型的癌症的预后较差有关。计算机断层扫描（CT）常用于评估骨骼肌质量，并进一步计算第三腰椎水平（L3）的骨骼肌指数（SMI），用于定义肌少症。本荟萃分析的目的是评估直肠癌患者肌少症对总生存期（OS）的预后价值。
我们进行了系统搜索，以查找截至 2021 年 1 月 14 日在 PubMed、Embase、Web of science 和 Scopus 上发表的相关研究。在我们的荟萃分析中，纳入了比较直肠癌患者有肌少症与无肌少症的 OS 的研究。根据预后研究质量（QUIPS）工具评估纳入研究的质量。我们直接从每项研究的单变量和多变量分析中提取风险比（HRs）及其 95%置信区间（CIs）。采用 Cochrane 协作的 Review Manager 5.4 软件分析数据。使用推荐评估、制定与评价（GRADE）指南和 GRADEpro 网站评估证据质量。
最终，共纳入 7 项研究，涉及 2377 名患者。使用随机效应模型，在单变量和多变量分析中，汇总 HRs 分别为 2.10（95% CI 1.33-3.32，P = 0.001）和 2.37（95% CI 1.13-4.98，P = 0.02）。结果表明，直肠癌患者肌少症与 OS 之间存在显著关联。OS 的证据质量在单变量和多变量分析中均为中等。
CT 定义的肌少症是直肠癌患者 OS 不良的独立预测因子。需要进一步的研究来确认我们的发现，这些研究需要更严格的肌少症定义。
