Pretreatment Skeletal Muscle Index and Survival Outcomes in Non-Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational prognostic cohort studies
PubMed 40576903 · doi:10.1007/s12029-025-01267-z
What was done
Authors searched PubMed, Embase, SCOPUS, Web of Science, Cochrane Library, and ClinicalTrials.gov from inception through March 24, 2025, for studies evaluating pretreatment skeletal muscle index (SMI, measured via CT at L3) and survival outcomes in non-metastatic colorectal cancer (CRC). Study quality was evaluated using the Newcastle-Ottawa Scale. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and disease-free survival (DFS) were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic.
What was found
Seventeen studies comprising 16,031 patients were analyzed: - Low SMI was associated with a 28% higher risk of overall mortality (pooled HR for OS: 1.28, 95% CI: 1.04–1.57, p = 0.02). - Low SMI was associated with a 23% higher risk of recurrence or progression (pooled HR for DFS: 1.23, 95% CI: 1.02–1.49, p = 0.02). - Heterogeneity was reported as high across the included studies.
Why it matters
Because SMI is measurable from standard staging CT scans without added imaging costs or radiation, it serves as a pragmatic prognostic marker to risk-stratify non-metastatic CRC patients undergoing curative-intent therapy.
Limits
The findings are limited by high heterogeneity across studies due to variable SMI cutoffs and observational study designs. The abstract does not report specific numerical I² percentages, Newcastle-Ottawa quality score breakdowns, or adjustment factors used across primary studies.
Cited by
- supports Skeletal muscle mass and lean muscle mass are strongly associated with physical functioning and quality of life, and predict cancer recurrence and survival outcomes in cancer patients.