Tatyana Sergeevna Dikova1, Alina Yurievna Zatsepina2, Denis Sergeevich Fedorinov3, Vladimir Konstantinovich Lyadov4. 1. Department of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia. Electronic address: dikovatatyanasergeevna@gmail.com. 2. Department of Oncology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. Electronic address: zatsepina.alina@gmail.com. 3. Department of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia. Electronic address: deni_fe@mail.com. 4. Head of the Division of Oncology №4, Moscow Clinical Oncology Hospital № 1 of the Moscow Healthcare Department, Moscow, Russia; Associate Professor at the Chair of Oncology and Palliative Medicine named after Academician I.A. Savitsky, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Head of the Chair of Oncology, Novokuznetsk State Institute for Continuous Medical Education, Novokuznetsk, Russia. Electronic address: vlyadov@gmail.com.
Abstract
BACKGROUND: GI tract cancer includes a broad spectrum of tumors with generally high prevalence and poor prognosis. Over the past decade sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have a negative prognostic impact in patients with various malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We systematically reviewed data on the prevalence and prognostic impact of SO for patients with GI malignancies, undergoing surgical and/or chemotherapeutical treatment. METHODS: This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were searched for relevant original studies published between January 2008 to December 2020 reporting postoperative morbidity and mortality, long-term survival and toxicity after chemotherapeutical treatment in SO patients with GI cancer. RESULTS: Twenty-two studies comprising 8571 patients were included. The percentage of SO patients ranged from 2.6% to 51%. The association between SO and outcomes of interest was inconsistent because of various cut-offs used to define sarcopenia and obesity. However, SO was significantly associated with the occurrence of major postoperative complications in five studies. In contrast, three studies did not show the impact of SO on postoperative complications. Three studies demonstrated that mortality rate was significantly higher among patients with SO. Five studies of systematic review revealed a statistically significant influence of SO on overall survival in multivariate analysis. However, only in one of them a significant difference was found between SO and DFS. Three studies evaluated toxicity after chemotherapy and all reported statistically significant negative impact of SO. CONCLUSIONS: There is considerable heterogeneity in methods used to define SO in the literature and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the influence of obesity and sarcopenia on the clinical trajectory of patients with GI cancer.
BACKGROUND: GI tract cancer includes a broad spectrum of tumors with generally high prevalence and poor prognosis. Over the past decade sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have a negative prognostic impact in patients with various malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We systematically reviewed data on the prevalence and prognostic impact of SO for patients with GI malignancies, undergoing surgical and/or chemotherapeutical treatment. METHODS: This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were searched for relevant original studies published between January 2008 to December 2020 reporting postoperative morbidity and mortality, long-term survival and toxicity after chemotherapeutical treatment in SO patients with GI cancer. RESULTS: Twenty-two studies comprising 8571 patients were included. The percentage of SO patients ranged from 2.6% to 51%. The association between SO and outcomes of interest was inconsistent because of various cut-offs used to define sarcopenia and obesity. However, SO was significantly associated with the occurrence of major postoperative complications in five studies. In contrast, three studies did not show the impact of SO on postoperative complications. Three studies demonstrated that mortality rate was significantly higher among patients with SO. Five studies of systematic review revealed a statistically significant influence of SO on overall survival in multivariate analysis. However, only in one of them a significant difference was found between SO and DFS. Three studies evaluated toxicity after chemotherapy and all reported statistically significant negative impact of SO. CONCLUSIONS: There is considerable heterogeneity in methods used to define SO in the literature and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the influence of obesity and sarcopenia on the clinical trajectory of patients with GI cancer.