Zhang Yujie, Zhang Jingjing, Zhan Yunfan, Pan Zhe, Liu Qiaohong, Yuan Wei'an
Clinical Research Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2295-2310. doi: 10.1002/jcsm.13629. Epub 2024 Nov 11.
The relationship between sarcopenia and the prognosis of patients with tumours who received radio- and/or chemotherapy still needs to be determined. In this study, we aim to investigate the relationship between sarcopenia and adverse effects and mortality in patients with tumours that received radio- and/or chemotherapy, stratified by study design, tumour category, the method sarcopenia assessed, treatment options, study location and among other factors.
PubMed, Web of Science and Embase were searched from inception to 15 August 2024, without language restrictions and with a manual search of references for additional articles retrieval. Cohort studies of ≥ 100 patients with tumours that evaluated the association between sarcopenia or muscle mass and the adverse effects or overall survival induced by radio- and/or chemotherapy were included.
Thirty-nine studies were included, involving 8966 patients with tumours, including 3383 patients with sarcopenia. The pooled prevalence of sarcopenia in patients with tumours was 0.42 (95% CI 0.36-0.48, p < 0.001) overall. The prevalence of sarcopenia is higher in Oceania patients 0.60 (95% CI 0.28-0.89, p < 0.001), those with reproductive tumour 0.57 (95% CI 0.30-0.83, p < 0.001), and sarcopenia assessed by the lumbar-skeletal muscle index 0.46 (95% CI 0.39-0.53, p < 0.001) than in other subgroups, but not show significant differences in sex. Sarcopenia was associated with an increased risk of adverse effects in patients who received radio- and/or chemotherapy, with a relative risk (RR) of 1.44 (95% CI 1.21-1.71, p < 0.001). Retrospective studies (RR = 1.49; 95% CI 1.24-1.79; p < 0.001), sarcopenia assessed by other methods (RR = 2.98; 95% CI 1.52-5.87; p < 0.001), and patients in Europe (RR = 1.92; 95% CI 1.15-3.22; p = 0.013), received chemoradiotherapy (RR = 1.47; 95% CI 1.23-1.76; p < 0.001), and with head and neck tumours (RR = 1.54; 95% CI 1.17-2.01; p = 0.010) had higher relative risk than other subgroups. Sarcopenia was also associated with reduced overall survival in patients with tumours, with a pooled hazard ratio (HR) of 1.66 (95% CI 1.40-1.96, p < 0.001). Prospective studies (HR = 1.72; 95% CI 0.97-3.07; p = 0.065), sarcopenia assessed by the cervical-skeletal muscle index (HR = 2.66; 95% CI 1.73-4.09; p < 0.001), and patients in Asia (HR = 1.91; 95% CI 1.50-2.42; p < 0.001), received chemoradiotherapy (HR = 1.85; 95% CI 1.46-2.45; p < 0.001) and with head and neck tumours (HR = 2.35; 95% CI 1.88-2.95; p < 0.001) had higher HR than other subgroups.
Sarcopenia was associated with a higher risk of adverse effects and mortality in patients with tumours received radio- and/or chemotherapy.
肌肉减少症与接受放疗和/或化疗的肿瘤患者预后之间的关系仍有待确定。在本研究中，我们旨在探讨肌肉减少症与接受放疗和/或化疗的肿瘤患者的不良反应及死亡率之间的关系，并按研究设计、肿瘤类别、肌肉减少症评估方法、治疗方案、研究地点等因素进行分层。
检索了从创刊至2024年8月15日的PubMed、Web of Science和Embase，无语言限制，并手动检索参考文献以获取更多文章。纳入了对≥100例肿瘤患者进行的队列研究，这些研究评估了肌肉减少症或肌肉量与放疗和/或化疗引起的不良反应或总生存期之间的关联。
纳入39项研究，涉及8966例肿瘤患者，其中3383例为肌肉减少症患者。总体而言，肿瘤患者中肌肉减少症的合并患病率为0.42（95%CI 0.36-0.48，p<0.001）。大洋洲患者（0.60，95%CI 0.28-0.89，p<0.001）、生殖系统肿瘤患者（0.57，95%CI 0.30-0.83，p<0.001）以及通过腰椎骨骼肌指数评估为肌肉减少症的患者（0.46，95%CI 0.39-0.53，p<0.001）的肌肉减少症患病率高于其他亚组，但性别方面未显示出显著差异。肌肉减少症与接受放疗和/或化疗的患者出现不良反应的风险增加相关，相对风险（RR）为1.44（95%CI 1.21-1.71，p<0.001）。回顾性研究（RR=1.49；95%CI 1.24-1.79；p<0.001）、通过其他方法评估为肌肉减少症的患者（RR=2.98；95%CI 1.52-5.87；p<0.001）以及欧洲患者（RR=1.92；95%CI 1.15-3.22；p=0.013）、接受放化疗的患者（RR=1.47；95%CI 1.23-1.76；p<0.001）以及患有头颈部肿瘤的患者（RR=1.54；95%CI 1.17-2.01；p=0.010）的相对风险高于其他亚组。肌肉减少症还与肿瘤患者的总生存期缩短相关，合并危险比（HR）为1.66（95%CI 1.40-1.96，p<0.001）。前瞻性研究（HR=1.72；95%CI 0.97-3.07；p=0.065）、通过颈椎骨骼肌指数评估为肌肉减少症的患者（HR=2.66；95%CI 1.73-4.09；p<0.001）以及亚洲患者（HR=1.91；95%CI 1.50-2.42；p<0.001）接受放化疗的患者（HR=1.85；95%CI 1.46-2.45；p<0.001）以及患有头颈部肿瘤的患者（HR=2.35；95%CI 1.88-2.95；p<0.001）的HR高于其他亚组。
肌肉减少症与接受放疗和/或化疗的肿瘤患者出现不良反应及死亡的风险较高相关。
