DataSheet_1_Impact and Treatment of Sarcopenia in Patients Undergoing Radiotherapy: A Multidisciplinary, AMSTAR-2 Compliant Review of Systematic Reviews and Metanalyses.docx

BackgroundSarcopenia (SP) is defined as the quantitative and functional impairment of skeletal muscles. SP is commonly related to older age and is frequent in patients with cancer. To provide an overview of SP in patients treated with radiotherapy (RT) and to evaluate the current evidence, we analyzed the available systematic reviews and meta-analyses.
MethodsReviews were identified using PubMed, Scopus, and Cochrane library databases, without date restriction. Only systematic reviews and meta-analyses on the prognostic impact of SP and on any treatments aimed at reducing SP effect, in patients undergoing RT, were included in this review. The analyses not separately reporting the results in patients treated with RT were excluded. The quality assessment was performed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews).
ResultsFrom the 84 papers identified, five reviews met the inclusion criteria with four reports mainly including non-randomized trials. Three reviews on the effect of SP showed a significantly negative impact on overall survival in patients undergoing RT and/or chemoradiation for H&N cancers (HR: 1.63-2.07). Two reviews on interventional studies showed the possibility of 1) improving physical functions through nutritional and physical interventions and 2) avoiding muscle wasting by means of sufficient protein intake. The quality assessment of the included review showed that two and three analyses are classifiable as having low and moderate overall confidence rating, respectively.
ConclusionsThe analyzed reviews uniformly confirmed the negative impact of SP in patients with H&N tumors undergoing RT and the possibility of improving muscle mass and function through nutritional and physical interventions. These results justify further research on this topic based on a more uniform SP definition and on a complete evaluation of the potentially confounding parameters.

背景 肌少症（Sarcopenia，SP）被定义为骨骼肌的数量减少与功能减退。肌少症常与高龄相关，且在癌症患者中高发。为全面概述接受放射治疗（RT）患者的肌少症现状并评估现有证据，本研究对现有系统评价与荟萃分析进行了系统性梳理与分析。
方法 本研究通过PubMed、Scopus及Cochrane图书馆数据库检索相关文献，未设置时间限制。仅纳入针对接受放射治疗的患者中肌少症的预后影响，以及旨在减轻肌少症不良效应的各类干预措施的系统评价与荟萃分析。未单独报告放射治疗患者亚组结果的分析予以排除。研究质量采用AMSTAR-2（系统评价研究方法学质量评价工具，A MeaSurement Tool to Assess systematic Reviews）进行评估。
结果 初检共检索到84篇文献，其中5篇符合纳入标准，其中4项纳入研究主要纳入非随机对照试验。3项针对肌少症效应的系统评价显示，肌少症对头颈部肿瘤患者接受放射治疗或放化疗后的总生存期存在显著负面影响（风险比（Hazard Ratio，HR）：1.63~2.07）。2项针对干预性研究的系统评价表明：一是通过营养与运动干预可改善躯体功能；二是通过充足的蛋白质摄入可避免肌肉消耗。对纳入研究的质量评估显示，2项分析整体置信度为低水平，3项为中水平。
结论 本研究所纳入的系统评价一致证实，肌少症对头颈部肿瘤患者接受放射治疗存在负面影响，且通过营养与运动干预可改善骨骼肌质量与功能。上述结果支持基于统一的肌少症定义，并全面评估潜在混杂因素的同类后续研究开展。