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Sarcopenic obesity and therapeutic outcomes in gastrointestinal surgical oncology: A meta-analysis
Peiyu Wang1, Shaodong Wang1, Yi Ma1
1Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China.
Background:
Sarcopenic obesity (SO) has been indicated as a scientific and clinical priority in oncology. This meta-analysis aimed to investigate the impacts of preoperative SO on therapeutic outcomes in gastrointestinal surgical oncology.
Methods:
We searched the PubMed, EMBASE, and Cochrane Library databases through March 4th 2022 to identify cohort studies. Endpoints included postoperative complications and survival outcomes. Newcastle Ottawa Scale was used for quality assessment. Heterogeneity and publication bias were assessed. Subgroup analyses and sensitivity analyses were performed.
Results:
Twenty-six studies (8,729 participants) with moderate to good quality were included. The pooled average age was 65.6 [95% confidence interval (CI) 63.7-67.6] years. The significant heterogeneity in SO definition and diagnosis among studies was observed. Patients with SO showed increased incidences of total complications (odds ratio 1.30, 95% CI: 1.03-1.64, P = 0.030) and major complications (Clavien-Dindo grade ≥ IIIa, odds ratio 2.15, 95% CI: 1.39-3.32, P = 0.001). SO was particularly associated with the incidence of cardiac complications, leak complications, and organ/space infection. SO was also predictive of poor overall survival (hazard ratio 1.73, 95% CI: 1.46-2.06, P < 0.001) and disease-free survival (hazard ratio 1.41, 95% CI: 1.20-1.66, P < 0.001). SO defined as sarcopenia in combination with obesity showed greater association with adverse outcomes than that defined as an increased ratio of fat mass to muscle mass. A low prevalence rate of SO (< 10%) was associated with increased significance for adverse outcomes compared to the high prevalence rate of SO (> 20%).
Conclusion:
The SO was associated with increased complications and poor survival in gastrointestinal surgical oncology. Interventions aiming at SO have potentials to promote surgery benefits for patients with gastrointestinal cancers. The heterogeneity in SO definition and diagnosis among studies should be considered when interpreting these findings.
Systematic Review Registration:
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255286], identifier [CRD42021255286].
Insights
Preoperative sarcopenic obesity (SO) significantly increases complications and reduces survival in gastrointestinal cancer surgery. Addressing SO may improve patient outcomes in oncology.
Area of Science:
- Oncology
- Surgical Gastroenterology
- Metabolic Health
Background:
- Sarcopenic obesity (SO) is a growing concern in oncology, impacting patient prognosis.
- This meta-analysis focuses on the clinical significance of preoperative SO in gastrointestinal surgical oncology.
Approach:
- Systematic review and meta-analysis of 26 cohort studies (8,729 participants) published up to March 2022.
- Utilized PubMed, EMBASE, and Cochrane Library databases for study identification.
- Assessed postoperative complications and survival outcomes using Newcastle Ottawa Scale for quality appraisal.
Key Points:
- Preoperative SO is linked to higher rates of total (OR 1.30) and major complications (OR 2.15).
- SO is associated with increased cardiac complications, leaks, and infections.
- SO predicts poorer overall survival (HR 1.73) and disease-free survival (HR 1.41).
- Specific definitions of SO and prevalence rates influence outcome associations.
Conclusions:
- Preoperative sarcopenic obesity negatively impacts outcomes in gastrointestinal surgical oncology.
- Interventions targeting SO could enhance surgical benefits for cancer patients.
- Heterogeneity in SO definitions necessitates careful interpretation of findings.
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