Wang Fang, Zhen Hongnan, Yu Kang, Liu Pengju
Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China.
Department of Radiology, Peking Union Medical College Hospital, Beijing, China.
J Cachexia Sarcopenia Muscle. 2025 Feb;16(1):e13674. doi: 10.1002/jcsm.13674.
Sarcopenia is a condition characterized by inadequate muscle and function decline and is often associated with ageing and cancer. It is established that sarcopenia and muscle loss occurred during treatment are associated with the clinical outcomes of patients with cancer. This systematic review and meta-analysis aims to evaluate the association between sarcopenia at pretreatment and during treatment and overall survival or disease progression in patients with cervical cancer.
The Web of Science, Embase, Medline and Cochrane Library databases were searched until 4 July 2024. Studies evaluating the prognostic effect of muscle mass at pretreatment or muscle change during treatment on survival or disease progression for patients with cervical cancer were included. Study quality was evaluated with the Newcastle-Ottawa Scale (NOS). Forest plots and summary effect models were used to show the effect size of sarcopenia on clinical outcomes.
The search strategy yielded 1721 studies in four databases. Eleven and seven studies were included in the quantitative analysis of pretreatment sarcopenia and muscle change on clinical outcomes, respectively. A total of 1907 patients underwent pretreatment muscle assessment, but 1016 were monitored for muscle changes; however, none of the studies involved measures of muscle strength or function. Meta-analysis showed a significant association between pretreatment sarcopenia and OS [hazard ratio (HR) 1.58, 95% confidence interval (CI): 1.16-2.14, p = 0.003] and PFS (HR 1.63, 95%CI 1.16-2.29, p = 0.005) according to data of univariate analysis. In the meta-analysis of the multivariate data, pretreatment sarcopenia remained associated with poor OS (HR 3.09, 95% CI: 2.07-4.61, p < 0.00001) and PFS (HR: 1.55, 95%CI 1.06-2.28, p = 0.03). Additionally, muscle loss was significantly associated with OS (HR 5.18, 95%CI 3.54-7.56, p < 0.00001) and PFS (HR 2.62, 95%CI 1.63-4.22, p < 0.00001). Subgroup analysis showed that the association between pretreatment sarcopenia and OS, as well as PFS, was influenced by muscle mass measurements and cut-off values, whereas muscle loss consistently predicted worse OS and PFS when stratified by varying degrees of reduction. The NOS scores of all included studies were ≥ 6.
Pretreatment sarcopenia and muscle change during treatment are significantly associated with both overall survival and disease progression. Therefore, muscle assessment and monitoring should be conducted for appropriate diagnosis and intervention to improve clinical outcomes in patients with cervical cancer.
肌肉减少症是一种以肌肉量不足和功能衰退为特征的病症，常与衰老和癌症相关。已证实，肌肉减少症以及治疗期间发生的肌肉流失与癌症患者的临床结局相关。本系统评价和荟萃分析旨在评估宫颈癌患者治疗前和治疗期间的肌肉减少症与总生存期或疾病进展之间的关联。
检索了Web of Science、Embase、Medline和Cochrane图书馆数据库，检索截止至2024年7月4日。纳入评估治疗前肌肉量或治疗期间肌肉变化对宫颈癌患者生存或疾病进展的预后影响的研究。采用纽卡斯尔-渥太华量表（NOS）评估研究质量。森林图和汇总效应模型用于显示肌肉减少症对临床结局的效应大小。
检索策略在四个数据库中产生了1721项研究。分别有11项和7项研究纳入了治疗前肌肉减少症和肌肉变化对临床结局的定量分析。共有1907例患者接受了治疗前肌肉评估，但其中1016例接受了肌肉变化监测；然而，所有研究均未涉及肌肉力量或功能的测量。荟萃分析显示，根据单变量分析数据，治疗前肌肉减少症与总生存期[风险比（HR）1.58，95%置信区间（CI）：1.16 - 2.14，p = 0.003]和无进展生存期（HR 1.63，95%CI 1.16 - 2.29，p = 0.005）显著相关。在多变量数据的荟萃分析中，治疗前肌肉减少症仍与较差的总生存期（HR 3.09，95%CI：2.07 - 4.61，p < 0.00001）和无进展生存期（HR：1.55，95%CI 1.06 - 2.28，p = 0.03）相关。此外，肌肉流失与总生存期（HR 5.18，95%CI 3.54 - 7.56，p < 0.00001）和无进展生存期（HR 2.62，95%CI 1.63 - 4.22，p < 0.00001）显著相关。亚组分析表明，治疗前肌肉减少症与总生存期以及无进展生存期之间的关联受肌肉量测量和截断值的影响，而当按不同程度的减少进行分层时，肌肉流失始终预示着更差的总生存期和无进展生存期。所有纳入研究的NOS评分均≥6。
治疗前肌肉减少症和治疗期间的肌肉变化均与总生存期和疾病进展显著相关。因此，应进行肌肉评估和监测，以进行适当的诊断和干预，改善宫颈癌患者的临床结局。
