Wang Peiyu, Wang Shaodong, Ma Yi, Li Haoran, Liu Zheng, Lin Guihu, Li Xiao, Yang Fan, Qiu Mantang
Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China.
Department of Thoracic Surgery, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, China.
Front Nutr. 2022 Jul 22;9:921817. doi: 10.3389/fnut.2022.921817. eCollection 2022.
Sarcopenic obesity (SO) has been indicated as a scientific and clinical priority in oncology. This meta-analysis aimed to investigate the impacts of preoperative SO on therapeutic outcomes in gastrointestinal surgical oncology.
We searched the PubMed, EMBASE, and Cochrane Library databases through March 4th 2022 to identify cohort studies. Endpoints included postoperative complications and survival outcomes. Newcastle Ottawa Scale was used for quality assessment. Heterogeneity and publication bias were assessed. Subgroup analyses and sensitivity analyses were performed.
Twenty-six studies (8,729 participants) with moderate to good quality were included. The pooled average age was 65.6 [95% confidence interval (CI) 63.7-67.6] years. The significant heterogeneity in SO definition and diagnosis among studies was observed. Patients with SO showed increased incidences of total complications (odds ratio 1.30, 95% CI: 1.03-1.64, = 0.030) and major complications (Clavien-Dindo grade ≥ IIIa, odds ratio 2.15, 95% CI: 1.39-3.32, = 0.001). SO was particularly associated with the incidence of cardiac complications, leak complications, and organ/space infection. SO was also predictive of poor overall survival (hazard ratio 1.73, 95% CI: 1.46-2.06, < 0.001) and disease-free survival (hazard ratio 1.41, 95% CI: 1.20-1.66, < 0.001). SO defined as sarcopenia in combination with obesity showed greater association with adverse outcomes than that defined as an increased ratio of fat mass to muscle mass. A low prevalence rate of SO (< 10%) was associated with increased significance for adverse outcomes compared to the high prevalence rate of SO (> 20%).
The SO was associated with increased complications and poor survival in gastrointestinal surgical oncology. Interventions aiming at SO have potentials to promote surgery benefits for patients with gastrointestinal cancers. The heterogeneity in SO definition and diagnosis among studies should be considered when interpreting these findings.
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255286], identifier [CRD42021255286].
肌少症性肥胖（SO）已被视为肿瘤学领域的一个科学和临床重点问题。本荟萃分析旨在探讨术前SO对胃肠外科肿瘤治疗结局的影响。
我们检索了截至2022年3月4日的PubMed、EMBASE和Cochrane图书馆数据库，以识别队列研究。结局指标包括术后并发症和生存结局。采用纽卡斯尔渥太华量表进行质量评估。评估了异质性和发表偏倚。进行了亚组分析和敏感性分析。
纳入了26项质量中等至良好的研究（8729名参与者）。汇总平均年龄为65.6岁[95%置信区间（CI）63.7 - 67.6]。观察到各研究在SO定义和诊断方面存在显著异质性。SO患者的总并发症发生率增加（优势比1.30，95% CI：1.03 - 1.64，P = 0.030），主要并发症（Clavien - Dindo分级≥IIIa）发生率增加（优势比2.15，95% CI：1.39 - 3.32，P = 0.001）。SO尤其与心脏并发症、吻合口漏并发症及器官/腔隙感染的发生率相关。SO还可预测总体生存不良（风险比1.73，95% CI：1.4
