Chest
Volume 156, Issue 1, July 2019, Pages 101-111
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Original Research: Lung Cancer
Prognostic Value of Sarcopenia in Lung Cancer: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.chest.2019.04.115 Get rights and content

Background

Evidence regarding the association between sarcopenia (skeletal muscle depletion) and outcomes in patients with lung cancer varies across studies. We aimed to systematically review the prognostic value of sarcopenia in lung cancer.

Methods

We searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through July 23, 2018 to identify retrospective or prospective cohort studies. We applied the Quality in Prognostic Studies instrument to assess the risk of bias in individual studies. We examined the heterogeneity and publication bias and performed subgroup analyses and sensitivity analyses.

Results

We included 13 studies (1,810 participants). The pooled prevalence of sarcopenia was 43% in patients with non-small cell lung cancer (NSCLC) and 52% in patients with small cell lung cancer (SCLC). Sarcopenia was associated with a shorter overall survival (OS) in patients with lung cancer (hazard ratio [HR], 2.23; 95% CI, 1.68-2.94). This association existed for both NSCLC (HR, 2.57; 95% CI, 1.79-3.68) and SCLC (HR, 1.59; 95% CI, 1.17-2.14). Sarcopenia was an independent predictor of shorter OS in both stage I-II NSCLC (HR, 3.23; 95% CI, 1.68-6.23) and stage III-IV NSCLC (HR, 2.19; 95% CI, 1.14-4.24). However, sarcopenia was not an independent predictor of disease-free survival in patients with NSCLC (HR, 1.28; 95% CI, 0.44-3.69).

Conclusions

Sarcopenia is highly prevalent in patients with lung cancer (approximately one in two) and an important predictor of impaired OS in patients with SCLC or with different stages of NSCLC.

Section snippets

Methods

During the process of conducting this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)21 guidelines.

Study Selection and Characteristics

We identified 883 papers (after the removal of duplicates), of which 758 were excluded after screening the titles and abstracts, leaving 25 studies for full review. After reading the full text, another 12 studies were excluded. The reasons for the exclusions are presented in e-Table 3. As a result, we included 13 studies11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 27, 28, 29 with a total of 1,810 participants. Figure 1 presents the PRISMA diagram for the study selection.

Table 1 presents the

Discussion

Our review found that the pooled prevalence of sarcopenia was 43% in NSCLC and 52% in SCLC. The pooled data demonstrated that sarcopenia was independently associated with shorter OS in both NSCLC and SCLC; however, sarcopenia did not appear to be associated with DFS. The association between sarcopenia and PFS appeared to be inconsistent in both NSCLC and SCLC according to two small studies.12, 18 Limited evidence implied that sarcopenia might not have an association with cancer progression,

Conclusion

Sarcopenia is highly prevalent in patients with lung cancer (approximately 1 in 2). Sarcopenia is an important predictor of impaired OS in patients with SCLC or with different stages of NSCLC, but it appears not to be a predictor of DFS in patients with NSCLC. More prospective studies are needed to explore the association between sarcopenia and PFS, treatment-related toxicity, functional impairments, and quality of life in patients with different types of lung cancer.

Acknowledgments

Author contributions: M. Y. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. M. Y., Y. S., L. T., and W. L. contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Financial/nonfinancial disclosures: None declared.

Role of sponsors: The sponsor had no role in the study design, execution, or the

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    FUNDING/SUPPORT: This review was supported by the Health and Family Planning Commission of Sichuan Province (No. ZH2018-102) and Post-Doctor Research Project, West China Hospital, Sichuan University (No. 18HXBH071).

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