Skeletal muscle wasting during neoadjuvant therapy as a prognosticator in patients with esophageal and esophagogastric junction cancer: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review of observational cohort studies.
PubMed 34990833 · doi:10.1016/j.ijsu.2021.106206
What was done
A systematic review and meta-analysis of cohort studies identified from PubMed, Embase, and Cochrane Library (searched through October 13, 2021) evaluated the impact of skeletal muscle wasting (SMW) and sarcopenia during neoadjuvant chemotherapy or chemoradiotherapy in patients with esophageal or esophagogastric junction cancer (EC/EGJC). Outcomes included quantified muscle loss, changes in sarcopenia prevalence, perioperative morbidities, overall survival (OS), and recurrence-free survival (RFS).
What was found
Twenty-five cohort studies (n = 2,706) were analyzed. During neoadjuvant therapy, pooled muscle loss was -2.47 cm²/m² in skeletal muscle index and -0.23 cm²/m² in psoas muscle index, with a wasting proportion of 4.44%. Sarcopenia prevalence increased from 53.1% pre-treatment to 65.8% pre-surgery. Neoadjuvant chemoradiotherapy, older age, and male sex were risk factors for severe SMW. Severe SMW during neoadjuvant therapy was associated with worse overall survival (HR 1.92, P < 0.001) and recurrence-free survival (HR 1.51, P = 0.002), presenting higher hazard ratios than pre-neoadjuvant sarcopenia (OS HR 1.17, P = 0.036; RFS HR 1.27, P = 0.008) or pre-surgery sarcopenia (OS HR 1.28, P = 0.011; RFS HR 1.38, P = 0.006). Severe SMW was not significantly associated with perioperative morbidities.
Why it matters
Dynamic skeletal muscle loss during neoadjuvant therapy serves as a stronger prognostic marker for recurrence and mortality than static sarcopenia measurements in esophageal cancer patients.
Limits
The review relies entirely on observational cohort designs. The abstract omits confidence intervals, heterogeneity metrics (I²), and standardized diagnostic definitions/thresholds for muscle wasting across the included studies.
Cited by
- supports Low skeletal muscle mass in cancer patients is a critical driver of cancer recurrence and mortality.