Prevalence and clinical outcomes of sarcopenia in patients with esophageal, gastric or colorectal cancers receiving preoperative neoadjuvant therapy: A meta-analysis

Abstract

Objective To investigate the prevalence of sarcopenia and its impact on clinical outcomes in patients with EC, GC, or CRC receiving neoadjuvant therapy through Meta-analysis. Methods We searched the PubMed, Embase databases, and Cochrane Library for the prevalence of sarcopenia and its impact on clinical outcomes in EC, GC, or CRC patients treated with NAT from inception to November 2022. The primary endpoints were the prevalence of sarcopenia and overall survival in patients with EC, GC, or CRC treated with NAT. Secondary outcomes included recurrence-free survival, total postoperative complications, grade 3-4 chemotherapy toxicity, and 30-day mortality after surgery. Results 31 retrospective studies with 3651 subjects were included. In a fixed-effects model, the prevalence of muscle loss was higher in patients with EC, GC, or CRC at 50% (95% CI=42%-58%). The results of the multivariate analysis showed that preoperative patients with sarcopenia had a 1.91 times shorter overall survival (95% CI=1.61-2.27) and a 1.77 times shorter recurrence-free survival time (95% CI=1.33-2.35) than patients without sarcopenia and that patients with sarcopenia had a higher risk of total postoperative complications than patients without sarcopenia OR=1.27 (95% CI=1.03-1.57). However, the two groups had no statistical difference in grade 3-4 chemotherapy toxicity (P=0.84) and 30-d postoperative mortality (P=0.88). Conclusions The prevalence of sarcopenia in patients with EC, GC, or CRC during NAT is high, and it is associated with poorer clinical outcomes. Clinicians should closely monitor the changes in patient's body composition and guide patients to carry out reasonable diet and appropriate exercise to improve the poor prognosis and quality of life. Systematic review registration CRD42023387817.