Jiang Chuan, Wang Yanyan, Fu Wei, Zhang Guozhuan, Feng Xiaoshan, Wang Xing, Wang Fang, Zhang Le, Deng Yang
Department of Anoenterology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, China.
Health Management Center, Qilu Hospital of Shandong University, Jinan, China.
Front Nutr. 2022 Dec 14;9:978110. doi: 10.3389/fnut.2022.978110. eCollection 2022.
Sarcopenia, characterized by the loss of muscle mass, strength, and physical ability, occurs with aging and certain chronic illnesses such as chronic liver diseases and cancer. Sarcopenia is common in liver cirrhosis and hepatocellular carcinoma (HCC). Previous reports of association between sarcopenia and prognosis of HCC have been inconsistent. Therefore, the present systematic review and meta-analysis aimed to investigate the impact of sarcopenia on the survival of patients with HCC.
A systematic literature search was conducted using PubMed, EMBASE, and Web of Science electronic databases from inception to May 1, 2022. We included retrospective or prospective studies investigating the association between sarcopenia and overall survival (OS) and/or progression free survival (PFS) of HCC. We applied the Quality in Prognosis Studies (QUIPS) instrument to evaluate the risk of bias and quality of included studies. The primary and secondary outcomes were the associations of sarcopenia with OS and PFS, respectively, expressed by a pooled hazard ratio (HR) and corresponding 95% confidence interval (CI). Subgroup analysis and sensitivity analysis were performed. We further evaluated the publication bias by the funnel plot and Begg's test.
A total of 42 studies comprising 8,445 patients were included. The majority of included studies were at an overall low risk of bias. The pooled prevalence of sarcopenia was 39% (95% CI: 33-45%) ( = 8,203). Sarcopenia was associated with an increased risk of shorter OS, with a pooled adjusted HR of 1.84 (95% CI: 1.62-2.09). An independent association between sarcopenia and reduced PFS was observed (HR = 1.33, 95% CI: 1.12-1.56).
The prevalence of sarcopenia was approximately 39% among patients with HCC. Sarcopenia was independently associated with reduced OS and PFS in HCC irrespective of treatment modalities. It is imperative that interventions aimed at alleviating sarcopenia and restoring muscle mass be implemented in order to improve the survival of patients with HCC.
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337797], identifier [CRD42022337797].
肌肉减少症的特征是肌肉质量、力量和身体能力的丧失，随着年龄增长以及某些慢性疾病（如慢性肝病和癌症）而出现。肌肉减少症在肝硬化和肝细胞癌（HCC）中很常见。先前关于肌肉减少症与HCC预后之间关联的报道并不一致。因此，本系统评价和荟萃分析旨在研究肌肉减少症对HCC患者生存的影响。
使用PubMed、EMBASE和Web of Science电子数据库进行系统的文献检索，检索时间从数据库建立至2022年5月1日。我们纳入了调查肌肉减少症与HCC总生存期（OS）和/或无进展生存期（PFS）之间关联的回顾性或前瞻性研究。我们应用预后研究质量（QUIPS）工具来评估纳入研究的偏倚风险和质量。主要和次要结局分别是肌肉减少症与OS和PFS的关联，用合并风险比（HR）和相应的95%置信区间（CI）表示。进行亚组分析和敏感性分析。我们通过漏斗图和Begg检验进一步评估发表偏倚。
共纳入42项研究，涉及8445例患者。纳入的大多数研究总体偏倚风险较低。肌肉减少症的合并患病率为39%（95%CI：33 - 45%）（ = 8203）。肌肉减少症与较短OS风险增加相关，合并调整后HR为1.84（95%CI：1.62 - 2.09）。观察到肌肉减少症与PFS降低之间存在独立关联（HR = 1.33，95%CI：1.12 - 1.56）。
HCC患者中肌肉减少症的患病率约为39%。无论治疗方式如何，肌肉减少症与HCC患者的OS和PFS降低独立相关。必须实施旨在减轻肌肉减少症和恢复肌肉质量的干预措施，以提高HCC患者的生存率。
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337797]，标识符[CRD42022337797]。
