Sarcopenia and loss of muscle mass in patients with lung cancer undergoing chemotherapy treatment: a systematic review and meta-analysis

In patients with cancer, sarcopenia is associated with treatment related complications, treatment cessation, poor quality of life and reduced overall survival. Despite this, there is limited knowledge about changes in skeletal muscle mass during chemotherapy. The aim of this systematic review and meta-analysis was to investigate the change of skeletal muscle mass and sarcopenia during chemotherapy treatment among patients with lung cancer. A systematic literature search was conducted in three databases, PubMed, EMBASE and Web of Science. Observational studies with patients with lung cancer were eligible for inclusion if skeletal muscle mass was measured before and after receiving chemotherapy treatment. Ten cohort studies with a total of 867 participants met the inclusion criteria. During 5.2 ± 2.9 months of chemotherapy treatment, patients with lung cancer experienced a significant loss of skeletal muscle mass with a standardized mean difference (SMD) of: -0.25 (95% CI -0.47 to -0.03). The pretreatment prevalence of sarcopenia varied across studies from 35% to 74%. Only one study reported prevalence of sarcopenia both before and after chemotherapy treatment with an increase from 35% to 59%. The present data demonstrate a marked loss of skeletal muscle mass in patients with lung cancer undergoing chemotherapy treatment, as well as a high prevalence of sarcopenia. As sarcopenia is associated with poor clinical outcomes, it seems important to include and use assessments of skeletal muscle mass in clinical practice to identify patients in need for interventions. Moreover, interventional studies to hinder development of sarcopenia are needed.

在癌症患者群体中，肌肉减少症（sarcopenia）与治疗相关并发症、治疗中断、生活质量下降及总生存期缩短显著相关。尽管如此，当前学界对化疗期间骨骼肌质量变化的认知仍较为匮乏。本系统综述与荟萃分析旨在探讨肺癌患者化疗过程中骨骼肌质量及肌肉减少症的变化情况。研究团队在PubMed、EMBASE及Web of Science三大数据库中开展了系统性文献检索。纳入标准为针对肺癌患者、且在化疗前后均完成骨骼肌质量测量的观察性研究。最终共有10项队列研究符合纳入标准，累计纳入867名受试者。在为期5.2±2.9个月的化疗周期中，肺癌患者出现了显著的骨骼肌质量丢失，标准化均数差（standardized mean difference, SMD）为-0.25（95%置信区间：-0.47~-0.03）。不同研究中化疗前肌肉减少症的患病率存在较大异质性，范围为35%至74%。仅有1项研究同时报告了化疗前后的肌肉减少症患病率，其患病率从35%上升至59%。本研究数据表明，接受化疗的肺癌患者存在显著的骨骼肌质量丢失，且肌肉减少症患病率较高。鉴于肌肉减少症与不良临床结局密切相关，在临床实践中纳入并应用骨骼肌质量评估以识别需干预的患者，具备重要临床意义。此外，未来仍需开展干预性研究以阻止肌肉减少症的发生发展。