BackgroundThe 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.MethodsPubMed, 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.ResultsThirty‐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.ConclusionsSarcopenia was associated with a higher risk of adverse effects and mortality in patients with tumours received radio‐ and/or chemotherapy.

中文翻译：

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肌肉减少症是肿瘤患者不良反应和死亡率的预后因素：系统评价和荟萃分析


背景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。在这项研究中，我们旨在调查接受放疗和/或化疗的肿瘤患者肌肉减少症与不良反应和死亡率之间的关系，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。方法检索了从建库到 2024 年 8 月 15 日的 PubMed、Web of Science 和 Embase，没有语言限制，并手动检索参考文献以检索更多文章。纳入了 ≥ 100 名肿瘤患者的队列研究，这些研究评估了肌肉减少症或肌肉质量与放疗和/或化疗诱导的不良反应或总生存期之间的关联。结果共纳入 39 项研究，涉及 8966 例肿瘤患者，包括 3383 例肌肉减少症患者。肿瘤患者肌肉减少症的汇总患病率总体为 0.42 （95% CI 0.36-0.48，p < 0.001）。大洋洲患者的肌肉减少症患病率高于 0.60 （95% CI 0.28-0.89，p < 0.001），生殖肿瘤患者 0.57 （95% CI 0.30-0.83，p < 0.001），通过腰骨骼肌指数 0.46 评估的肌肉减少症 （95% CI 0.39-0.53，p < 0.001），但性别没有显着差异。肌肉减少症与接受放疗和/或化疗的患者不良反应风险增加相关，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），通过其他方法评估的肌肉减少症 （RR = 2.98;95% CI 1.52–5.87;p < 0.001） 和欧洲患者 （RR = 1.92;95% CI 1.15–3.22;p = 0.013）、接受放化疗 （RR = 1.47;95% CI 1.23–1.76;p < 0.001） 和头颈部肿瘤 （RR = 1.54;95% CI 1.17–2.01;p = 0.010） 的相对风险高于其他亚组。肌肉减少症也与肿瘤患者总生存期降低有关，汇总风险比 （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），通过颈骨骼肌指数评估的肌肉减少症（HR = 2.66;95% CI 1.73–4.09;p < 0.001）和亚洲患者 （HR = 1.91;95% CI 1.50–2.42;p < 0.001），接受放化疗 （HR = 1.85;95% CI 1.46–2.45;p < 0.001） 和头颈部肿瘤 （HR = 2.35;95% CI 1.88–2.95;p < 0.001） 的 HR 高于其他亚组。结论肌肉减少症与接受放疗和/或化疗的肿瘤患者不良反应和死亡风险较高相关。