Table 3_Sarcopenia as a prognostic marker in patients undergoing pancreaticoduodenectomy: an updated meta-analysis.docx

BackgroundSarcopenia is prevalent among patients undergoing pancreaticoduodenectomy (PD). However, the effect of sarcopenia on postoperative complications and the prognosis of patients undergoing PD remain controversial. This meta-analysis aimed to evaluate the potential use of sarcopenia as a prognostic indicator in patients undergoing PD.
MethodsA systematic search was conducted using the databases of Web of Science, EMBASE, China National Knowledge Infrastructure, Cochrane Library, and PubMed from inception to March 14, 2025, to identify studies on sarcopenia in patients undergoing PD. The pooled prevalence of sarcopenia and its 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I² test. Associations between sarcopenia and major postoperative complications, postoperative pancreatic fistula (POPF), postoperative biliary fistula (POBF), mortality, disease-free survival (DFS), and overall survival (OS) were expressed as odds ratios (ORs) or hazard ratios (HRs) with 95% CIs. Statistical analyses were performed using Stata version 11.0.
ResultsThis meta-analysis included 30 articles involving 5,323 participants. The prevalence of sarcopenia before PD was 35%. Patients with sarcopenia exhibited a significantly higher risk of major complications (Clavien–Dindo [CD] grade ≥ III) (OR = 1.84, 95% CI = 1.26–2.69, P = 0.002), POPF (OR = 1.47, 95% CI = 1.13–1.93, P = 0.004), and POBF (OR = 1.53, 95% CI = 1.05–2.25, P = 0.028) than those without sarcopenia. In addition, postoperative mortality was higher in patients with sarcopenia (OR = 3.52, 95% CI = 2.01–6.19, P = 0.002). Patients without sarcopenia exhibited better DFS and OS after PD than those with sarcopenia (DFS: HR = 2.28, 95% CI = 1.18–2.88, P < 0.001; OS: HR = 3.15, 95% CI = 2.49–3.98, P < 0.001).
ConclusionA high proportion of patients presented with sarcopenia before undergoing PD. Patients undergoing PD with sarcopenia face a higher risk of overall incidence of major complications (CD grade ≥ III), POPF, POBF, and mortality, and they exhibit worse DFS and OS than those without sarcopenia. Future studies should adopt stricter definitions of sarcopenia to further validate these findings.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42025635939, identifier CRD42025635939.

【背景】肌肉减少症（Sarcopenia）在接受胰十二指肠切除术（pancreaticoduodenectomy, PD）的患者中患病率较高。然而，肌肉减少症对PD术后并发症及患者预后的影响仍存在争议。本荟萃分析旨在评估肌肉减少症作为PD患者预后指标的潜在应用价值。
【方法】本研究以Web of Science、EMBASE、中国知网（China National Knowledge Infrastructure）、Cochrane图书馆及PubMed为检索数据库，建库至2025年3月14日进行系统检索，以筛选关于PD患者肌肉减少症的相关研究。计算肌肉减少症的合并患病率及其95%置信区间（confidence interval, CI），采用I²检验评估异质性。将肌肉减少症与术后严重并发症、术后胰瘘（postoperative pancreatic fistula, POPF）、术后胆瘘（postoperative biliary fistula, POBF）、死亡率、无病生存期（disease-free survival, DFS）及总生存期（overall survival, OS）的关联以比值比（odds ratios, ORs）或风险比（hazard ratios, HRs）及95%CI表示。统计学分析采用Stata 11.0软件完成。
【结果】本荟萃分析共纳入30项研究，涉及5323名研究对象。PD术前肌肉减少症的患病率为35%。与无肌肉减少症的患者相比，肌肉减少症患者发生严重并发症（克拉申-丹多分级[Clavien–Dindo, CD] ≥Ⅲ级）的风险显著升高（OR=1.84，95%CI=1.26~2.69，P=0.002）、术后胰瘘风险升高（OR=1.47，95%CI=1.13~1.93，P=0.004）、术后胆瘘风险升高（OR=1.53，95%CI=1.05~2.25，P=0.028）。此外，肌肉减少症患者的术后死亡率更高（OR=3.52，95%CI=2.01~6.19，P=0.002）。无肌肉减少症的PD患者术后无病生存期及总生存期均优于肌肉减少症患者（无病生存期：HR=2.28，95%CI=1.18~2.88，P<0.001；总生存期：HR=3.15，95%CI=2.49~3.98，P<0.001）。
【结论】接受PD治疗的患者中，术前肌肉减少症的占比较高。合并肌肉减少症的PD患者发生严重并发症（CD≥Ⅲ级）、术后胰瘘、术后胆瘘及术后死亡的整体风险更高，且其术后无病生存期与总生存期均差于无肌肉减少症的患者。未来的研究应采用更为严格的肌肉减少症定义，以进一步验证本研究结果。
【系统评价注册】https://www.crd.york.ac.uk/PROSPERO/view/CRD42025635939，注册编号：CRD42025635939。