Jang Min Kyeong, Park Sungwon, Park Chang, Raszewski Rebecca, Park Seho, Kim Sue
Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea.
Michigan Society of Fellows, University of Michigan, MI, USA.
Breast. 2025 May 22;82:104508. doi: 10.1016/j.breast.2025.104508.
Sarcopenia is associated with poor treatment outcomes and survival in early breast cancer and other cancer types. This systematic review and meta-analysis evaluated sarcopenia's prevalence and clinical implications for metastatic breast cancer-an area that remains underexplored.
A systematic literature review searched CINAHL, Cochrane Library, Embase, and Ovid MEDLINE for studies published before October 2024. A meta-analysis using a random- or fixed-effects model calculated mean differences in skeletal muscle index (SMI) and assessed the association with progression-free and overall survival. The study protocol was registered on PROSPERO (CRD42024557390).
Fourteen studies involving 1472 participants with metastatic breast cancer were included. The pooled overall sarcopenia prevalence was 41.6 % (95 % CI 35.4 %-48.7 %), with variability driven by differing SMI cutoffs (38-41 cm/m). The pooled mean SMI was 41.01 cm/m (95 % CI 38.81-43.21, p < .001), with significant heterogeneity (I = 95.3 %). Subgroup analysis revealed that patients treated with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors as first-line treatment had an SMI of 42.08 cm/m. Our synthesized review showed heterogeneous association between sarcopenia and poor treatment outcomes. Sarcopenia's impact on progression-free survival (hazard ratio = 1.17, 95 % CI 0.43-1.91) and overall survival (hazard ratio = 0.99, 95 % CI 0.96-1.01) was not statistically significant.
Sarcopenia is prevalent and clinically meaningful in metastatic breast cancer. While its direct role in survival remains inconclusive, early assessment of sarcopenia by molecular subtype and treatment timing is crucial for optimizing care.
肌肉减少症与早期乳腺癌及其他癌症类型的治疗效果不佳和生存率低有关。本系统评价和荟萃分析评估了肌肉减少症在转移性乳腺癌中的患病率及其临床意义，而该领域仍未得到充分研究。
通过系统文献检索，在CINAHL、Cochrane图书馆、Embase和Ovid MEDLINE中查找2024年10月之前发表的研究。使用随机或固定效应模型进行荟萃分析，计算骨骼肌指数（SMI）的平均差异，并评估其与无进展生存期和总生存期的关联。该研究方案已在PROSPERO（CRD42024557390）上注册。
纳入了14项研究，共1472例转移性乳腺癌患者。合并的总体肌肉减少症患病率为41.6%（95%CI 35.4%-48.7%），患病率的差异是由不同的SMI临界值（38-41cm/m）导致的。合并的平均SMI为41.01cm/m（95%CI 38.81-43.21，p<.001），具有显著的异质性（I=95.3%）。亚组分析显示，接受细胞周期蛋白依赖性激酶4和6（CDK4/6）抑制剂一线治疗的患者SMI为42.08cm/m。我们的综合评价显示，肌肉减少症与不良治疗结果之间的关联存在异质性。肌肉减少症对无进展生存期（风险比=1.17，95%CI 0.43-1.91）和总生存期（风险比=0.99，95%CI 0.96-1.01）的影响无统计学意义。
肌肉减少症在转移性乳腺癌中普遍存在且具有临床意义。虽然其对生存期的直接作用尚无定论，但通过分子亚型和治疗时机对肌肉减少症进行早期评估对于优化治疗至关重要。
