Pretreatment computed tomography-defined sarcopenia,
treatment-associated muscle loss and survival in cervical cancer: a
systematic review and meta-analysis
Abstract
Background: Sarcopenia has been identified as a predictor of
poor prognosis in various types of cancer. However, the impact of
pretreatment sarcopenia and the reduction of skeletal muscle mass during
treatment on prognosis of patients with cervical cancer is still not
well-understood. Objectives: To investigate the association
between sarcopenia and prognosis in patients with cervical cancer.
Search Strategy: Studies in PubMed, EMBASE, Web of Science, and
Cochrane databases were searched. Selection Criteria: Studies
exploring the relationship between computed tomography (CT)-defined
sarcopenia and the prognosis of cervical cancer were included.
Data Collection and Analysis: Our primary outcome was overall
survival (OS), secondary outcome was progression-free survival (PFS).
The pooled hazard ratio (HR) and 95% confidence interval (CI) of OS and
PFS were analyzed by R software. The studies’ quality was assessed using
the Quality in Prognostic Studies tool. Main Results: 12
studies involving 1593 patients with cervical cancer were included in
the analysis, with a prevalence of sarcopenia ranging from
24.8%-55.0%. Meta-analysis results showed that sarcopenia was an
independent predictor of poor OS (HR 1.70, 95% CI = 1.31-2.22; p
<0.01) and PFS (HR 1.35, 95% CI = 1.04-1.74; p =0.02) in
patients with cervical cancer. Skeletal muscle loss during treatment was
significantly associated with a short OS time (HR, 4.00; 95%
CI=2.63–6.08, p <0.01). Conclusions: The prevalence
of pretreatment sarcopenia was high among patients with cervical cancer.
Pretreatment sarcopenia and loss of skeletal muscle during the treatment
all had a negative effect on the prognosis in cervical cancer.