Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada.
Ann Surg. 2022 Nov 1;276(5):e311-e318. doi: 10.1097/SLA.0000000000005452. Epub 2022 Jul 6.
Sarcopenia has been identified as a prognostic factor among certain types of cancer. In esophageal cancer, patients are at increased risk of malnutrition and sarcopenia, ultimately contributing to poor outcomes. A systematic review was conducted to determine whether sarcopenia, defined by the skeletal muscle index, is predictive of overall survival, disease-free survival, and postoperative complications in resectable esophageal cancer.
A systematic search of MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines up until January 2021. The primary outcome was overall survival; secondary outcomes included disease-free survival, pulmonary complications, and anastomotic leak.
Twenty-one studies (4 prospective; 17 retrospective; 3966 patients) were included. Sarcopenia was present in 1940 (48.1%) patients and was associated with lower overall survival [hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.25-1.95; P <0.00001; I2 =71%] and disease-free survival (HR: 1.73; 95% CI: 1.04-2.87; P =0.03; I2 =51%). A decrease in skeletal muscle index, independent of sarcopenia status, was associated with lower overall survival (HR: 1.81; 95% CI: 1.20-2.73; P =0.005; I2 =92%). Sarcopenia was associated with increased odds of pulmonary complications (odds ratio: 1.86; 95% CI: 1.29-2.66; P =0.0008; I2 =41%) and increased odds of anastomotic leak (odds ratio: 1.46; 95% CI: 1.11-1.93; P =0.008; I2 =0%).
Sarcopenia is a predictor of overall survival, disease-free survival, and postoperative complications in patients with resectable esophageal cancer. Studies on the modifiability of sarcopenia in the preoperative period will help determine the utility of nutritional interventions.
肌肉减少症已被确定为某些类型癌症的预后因素。在食管癌中，患者存在营养不良和肌肉减少症的风险增加，最终导致不良结局。进行了一项系统评价，以确定通过骨骼肌指数定义的肌肉减少症是否可预测可切除食管癌患者的总生存率、无病生存率和术后并发症。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 MEDLINE、EMBASE、Scopus、Web of Science 和 Cochrane 图书馆进行了系统搜索，截至 2021 年 1 月。主要结局是总生存率；次要结局包括无病生存率、肺部并发症和吻合口漏。
纳入了 21 项研究（4 项前瞻性；17 项回顾性；3966 名患者）。1940 名（48.1%）患者存在肌肉减少症，与较低的总生存率相关[风险比（HR）：1.56；95%置信区间（CI）：1.25-1.95；P <0.00001；I2 =71%]和无病生存率（HR：1.73；95% CI：1.04-2.87；P =0.03；I2 =51%）。骨骼肌指数的降低，独立于肌肉减少症状态，与总生存率降低相关（HR：1.81；95% CI：1.20-2.73；P =0.005；I2 =92%）。肌肉减少症与肺部并发症的发生几率增加相关（比值比：1.86；95% CI：1.29-2.66；P =0.0008；I2 =41%）和吻合口漏的发生几率增加相关（比值比：1.46；95% CI：1.11-1.93；P =0.008；I2 =0%）。
肌肉减少症是可切除食管癌患者总生存率、无病生存率和术后并发症的预测指标。关于术前肌肉减少症可变性的研究将有助于确定营养干预的效用。
