Prevalence of computed tomography-based sarcopenia and the prognostic value of skeletal muscle index and muscle attenuation amongst women with epithelial ovarian malignancy: A systematic review and meta-analysis.
Tranoulis, Anastasios Kwong, Fong Lien Audrey Lakhiani, Aarti Georgiou, Dimitra Yap, Jason Balega, Janos
Tranoulis, Anastasios
Kwong, Fong Lien Audrey
Lakhiani, Aarti
Georgiou, Dimitra
Yap, Jason
Balega, Janos
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Sandwell and West Birmingham NHS Trust; Worcestershire Acute Hospitals NHS Trust; University of Birmingham
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Publication date
2022-02-24
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Abstract
Background: Sarcopenia represents an index of frailty amongst cancer patients and it is associated with poor oncological outcomes and a higher risk of surgical complications in several types of malignancy. Aim: To further delineate the impact of sarcopenia assessed via computed tomography scan (CT) on oncological outcomes and post-operative complications amongst women with epithelial ovarian carcinoma (EOC). Our secondary objective was to quantify and understand the prevalence of sarcopenia in EOC. Design: We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database, from inception up to August 2021. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). Outcomes consisted of prevalence, overall survival (OS), progression-free survival (PFS) and post-operative complications. Pooled analyses of proportion estimates, hazard ratios (HRs) and odds ratios (ORs) were performed with STATA and Review Manager 5.3. Results: 21 studies were included in this meta-analysis. NOS scores ranged from six to nine. Pooled analysis yielded an overall sarcopenia prevalence of 41%. Pooled analysis of adjusted HRs demonstrated significant association between low muscle attenuation (MA) [aHR = 1.23, (95% CI 1.02-1.47), p-value = 0.03] and OS, whilst low skeletal muscle index (SMI) trended towards shorter OS [aHR = 1.37, (95% CI 0.99-1.90), p-value = 0.05. Low-SMI was also associated with higher risk of total post-operative complications [uOR = 1.56, (95% CI 1.16-2.11), p-value = 0.004]. Conclusion: Our findings suggest that CT-assessed skeletal mass and radiodensity represent rather accurate indices of nutritional status and could prospectively be incorporated into the decision-making process in women with EOC.
Citation
Tranoulis A, Kwong FLA, Lakhiani A, Georgiou D, Yap J, Balega J. Prevalence of computed tomography-based sarcopenia and the prognostic value of skeletal muscle index and muscle attenuation amongst women with epithelial ovarian malignancy: A systematic review and meta-analysis. Eur J Surg Oncol. 2022 Jul;48(7):1441-1454. doi: 10.1016/j.ejso.2022.02.024
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Article