Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis
Computed tomographic (CT) imaging at third lumbar vertebra (L3), routinely used by oncologists, represents a reliable tool to quantify muscle mass. A systematic review and meta-analysis was performed to assess the efficacy of CT scan to define muscle mass as a prognostic marker in gastric cancer (GC...
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| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 2020-07, Vol.39 (7), p.2045-2054 |
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| creator | Rinninella, Emanuele Cintoni, Marco Raoul, Pauline Pozzo, Carmelo Strippoli, Antonia Bria, Emilio Tortora, Giampaolo Gasbarrini, Antonio Mele, Maria Cristina |
| description | Computed tomographic (CT) imaging at third lumbar vertebra (L3), routinely used by oncologists, represents a reliable tool to quantify muscle mass. A systematic review and meta-analysis was performed to assess the efficacy of CT scan to define muscle mass as a prognostic marker in gastric cancer (GC) patients undergoing gastrectomy and/or chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) and the secondary outcomes included postoperative length of hospital stay (P-LOS), total and severe complications in GC patients undergoing gastrectomy.
Three electronic bibliographic databases — MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials - were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until April 2019. The adjusted and unadjusted hazard ratio (HR), odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were used to analyse the dichotomous variables (OS, RFS, total and severe complications) and continuous variables (P-LOS). Random- and fixed effects models were used according to the heterogeneity.
A total of 5610 GC patients from 20 studies were identified. Low muscle mass at diagnosis was found in 32.7% of GC patients and was significantly associated with poorer OS (HR 2.02, 95% CI 1.71–2.38, p |
| doi_str_mv | 10.1016/j.clnu.2019.10.021 |
| format | Article |
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Three electronic bibliographic databases — MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials - were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until April 2019. The adjusted and unadjusted hazard ratio (HR), odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were used to analyse the dichotomous variables (OS, RFS, total and severe complications) and continuous variables (P-LOS). Random- and fixed effects models were used according to the heterogeneity.
A total of 5610 GC patients from 20 studies were identified. Low muscle mass at diagnosis was found in 32.7% of GC patients and was significantly associated with poorer OS (HR 2.02, 95% CI 1.71–2.38, p < 0.00001, I2 = 47%) and worse RFS (HR 1.97, 95% CI 1.71–2.26, p < 0.00001, I2 = 0%). Meta-analysis of adjusted HR from multivariable analyses confirmed the association between OS and low muscle mass (HR 1.89, 95% CI 1.68–2.12, p < 0.00001, I2 = 36%). Furthermore, low muscle mass and poorer OS were significantly associated in metastatic GC patients exclusively undergoing chemotherapy (HR 1.61, 95% CI 1.23–2.11, p < 0.0006, I2 = 18%). Moreover, preoperative low muscle mass was significantly associated with longer P-LOS (MD 1.19, 95% CI 0.68–1.71, p < 0.00001, I2 = 0%), higher risk of postoperative complications (OR 1.76, 95% CI 1.17–2.66, p = 0.007, I2 = 77%) and severe complications (OR 1.54, 95% CI 1.03–2.29, p = 0.04, I2 = 49%) in GC patients undergoing gastrectomy.
Low muscle mass, assessed by L3 CT-scan, affects almost 1/3 of GC patients at diagnosis and acts as a negative prognostic marker on many clinical outcomes. Therefore, identifying GC patients with low muscle mass at diagnosis or at follow-up visit should be recommendable. Clinical nutritionists should be part of tumor boards meetings to screen low muscle mass in order to prompt personalized nutritional support.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2019.10.021</identifier><identifier>PMID: 31718876</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Disease-related malnutrition ; Gastric cancer ; Muscle mass ; Personalised medicine ; Sarcopenia ; Tumor boards</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2020-07, Vol.39 (7), p.2045-2054</ispartof><rights>2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism</rights><rights>Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-6c6c2b6642990631eb062b817ba9ff21e98b9b344374d9a2b7124f3bcd99ac73</citedby><cites>FETCH-LOGICAL-c356t-6c6c2b6642990631eb062b817ba9ff21e98b9b344374d9a2b7124f3bcd99ac73</cites><orcidid>0000-0002-9165-2367</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clnu.2019.10.021$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31718876$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rinninella, Emanuele</creatorcontrib><creatorcontrib>Cintoni, Marco</creatorcontrib><creatorcontrib>Raoul, Pauline</creatorcontrib><creatorcontrib>Pozzo, Carmelo</creatorcontrib><creatorcontrib>Strippoli, Antonia</creatorcontrib><creatorcontrib>Bria, Emilio</creatorcontrib><creatorcontrib>Tortora, Giampaolo</creatorcontrib><creatorcontrib>Gasbarrini, Antonio</creatorcontrib><creatorcontrib>Mele, Maria Cristina</creatorcontrib><title>Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Computed tomographic (CT) imaging at third lumbar vertebra (L3), routinely used by oncologists, represents a reliable tool to quantify muscle mass. A systematic review and meta-analysis was performed to assess the efficacy of CT scan to define muscle mass as a prognostic marker in gastric cancer (GC) patients undergoing gastrectomy and/or chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) and the secondary outcomes included postoperative length of hospital stay (P-LOS), total and severe complications in GC patients undergoing gastrectomy.
Three electronic bibliographic databases — MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials - were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until April 2019. The adjusted and unadjusted hazard ratio (HR), odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were used to analyse the dichotomous variables (OS, RFS, total and severe complications) and continuous variables (P-LOS). Random- and fixed effects models were used according to the heterogeneity.
A total of 5610 GC patients from 20 studies were identified. Low muscle mass at diagnosis was found in 32.7% of GC patients and was significantly associated with poorer OS (HR 2.02, 95% CI 1.71–2.38, p < 0.00001, I2 = 47%) and worse RFS (HR 1.97, 95% CI 1.71–2.26, p < 0.00001, I2 = 0%). Meta-analysis of adjusted HR from multivariable analyses confirmed the association between OS and low muscle mass (HR 1.89, 95% CI 1.68–2.12, p < 0.00001, I2 = 36%). Furthermore, low muscle mass and poorer OS were significantly associated in metastatic GC patients exclusively undergoing chemotherapy (HR 1.61, 95% CI 1.23–2.11, p < 0.0006, I2 = 18%). Moreover, preoperative low muscle mass was significantly associated with longer P-LOS (MD 1.19, 95% CI 0.68–1.71, p < 0.00001, I2 = 0%), higher risk of postoperative complications (OR 1.76, 95% CI 1.17–2.66, p = 0.007, I2 = 77%) and severe complications (OR 1.54, 95% CI 1.03–2.29, p = 0.04, I2 = 49%) in GC patients undergoing gastrectomy.
Low muscle mass, assessed by L3 CT-scan, affects almost 1/3 of GC patients at diagnosis and acts as a negative prognostic marker on many clinical outcomes. Therefore, identifying GC patients with low muscle mass at diagnosis or at follow-up visit should be recommendable. Clinical nutritionists should be part of tumor boards meetings to screen low muscle mass in order to prompt personalized nutritional support.</description><subject>Disease-related malnutrition</subject><subject>Gastric cancer</subject><subject>Muscle mass</subject><subject>Personalised medicine</subject><subject>Sarcopenia</subject><subject>Tumor boards</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9UcuO1DAQtBCIHRZ-gAPykQMZ_EicGHFZjXhJg7jM3bKdzuIhcQa3w2r-hgNfwpfhaBaOSC231K4qdVcR8pyzLWdcvT5u_RiXrWBcl8GWCf6AbHgjRcV1Jx-SDROKV43i9RV5gnhkjDWy7R6TK8lb3nWt2pBfnxf0I9DJIr6i5YFSPbWZ9sHexhkDUneme1ntDhS9jQVDLT2lef3MwRdm-gaJzgP1Y4jB25HOS_bzBEhDpCebA8SM9C7kr_TWYk6FVIQ8pDf05vdPPGOGya5SCX4EuKM29nSCbCsb7XguGzwljwY7Ijy779fk8P7dYfex2n_58Gl3s6-8bFSulFdeOKVqoTVTkoNjSriOt87qYRAcdOe0k3Ut27rXVriWi3qQzvdaW9_Ka_LyIluu-74AZjMF9DCONsK8oBGS16KRnOsCFReoTzNigsGcUihOnA1nZg3HHM0ajlnDWWclnEJ6ca-_uAn6f5S_aRTA2wsAypHFimTQF_M89CGBz6afw__0_wA6J6Ng</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Rinninella, Emanuele</creator><creator>Cintoni, Marco</creator><creator>Raoul, Pauline</creator><creator>Pozzo, Carmelo</creator><creator>Strippoli, Antonia</creator><creator>Bria, Emilio</creator><creator>Tortora, Giampaolo</creator><creator>Gasbarrini, Antonio</creator><creator>Mele, Maria Cristina</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9165-2367</orcidid></search><sort><creationdate>202007</creationdate><title>Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis</title><author>Rinninella, Emanuele ; Cintoni, Marco ; Raoul, Pauline ; Pozzo, Carmelo ; Strippoli, Antonia ; Bria, Emilio ; Tortora, Giampaolo ; Gasbarrini, Antonio ; Mele, Maria Cristina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-6c6c2b6642990631eb062b817ba9ff21e98b9b344374d9a2b7124f3bcd99ac73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Disease-related malnutrition</topic><topic>Gastric cancer</topic><topic>Muscle mass</topic><topic>Personalised medicine</topic><topic>Sarcopenia</topic><topic>Tumor boards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rinninella, Emanuele</creatorcontrib><creatorcontrib>Cintoni, Marco</creatorcontrib><creatorcontrib>Raoul, Pauline</creatorcontrib><creatorcontrib>Pozzo, Carmelo</creatorcontrib><creatorcontrib>Strippoli, Antonia</creatorcontrib><creatorcontrib>Bria, Emilio</creatorcontrib><creatorcontrib>Tortora, Giampaolo</creatorcontrib><creatorcontrib>Gasbarrini, Antonio</creatorcontrib><creatorcontrib>Mele, Maria Cristina</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rinninella, Emanuele</au><au>Cintoni, Marco</au><au>Raoul, Pauline</au><au>Pozzo, Carmelo</au><au>Strippoli, Antonia</au><au>Bria, Emilio</au><au>Tortora, Giampaolo</au><au>Gasbarrini, Antonio</au><au>Mele, Maria Cristina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2020-07</date><risdate>2020</risdate><volume>39</volume><issue>7</issue><spage>2045</spage><epage>2054</epage><pages>2045-2054</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><abstract>Computed tomographic (CT) imaging at third lumbar vertebra (L3), routinely used by oncologists, represents a reliable tool to quantify muscle mass. A systematic review and meta-analysis was performed to assess the efficacy of CT scan to define muscle mass as a prognostic marker in gastric cancer (GC) patients undergoing gastrectomy and/or chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) and the secondary outcomes included postoperative length of hospital stay (P-LOS), total and severe complications in GC patients undergoing gastrectomy.
Three electronic bibliographic databases — MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials - were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until April 2019. The adjusted and unadjusted hazard ratio (HR), odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were used to analyse the dichotomous variables (OS, RFS, total and severe complications) and continuous variables (P-LOS). Random- and fixed effects models were used according to the heterogeneity.
A total of 5610 GC patients from 20 studies were identified. Low muscle mass at diagnosis was found in 32.7% of GC patients and was significantly associated with poorer OS (HR 2.02, 95% CI 1.71–2.38, p < 0.00001, I2 = 47%) and worse RFS (HR 1.97, 95% CI 1.71–2.26, p < 0.00001, I2 = 0%). Meta-analysis of adjusted HR from multivariable analyses confirmed the association between OS and low muscle mass (HR 1.89, 95% CI 1.68–2.12, p < 0.00001, I2 = 36%). Furthermore, low muscle mass and poorer OS were significantly associated in metastatic GC patients exclusively undergoing chemotherapy (HR 1.61, 95% CI 1.23–2.11, p < 0.0006, I2 = 18%). Moreover, preoperative low muscle mass was significantly associated with longer P-LOS (MD 1.19, 95% CI 0.68–1.71, p < 0.00001, I2 = 0%), higher risk of postoperative complications (OR 1.76, 95% CI 1.17–2.66, p = 0.007, I2 = 77%) and severe complications (OR 1.54, 95% CI 1.03–2.29, p = 0.04, I2 = 49%) in GC patients undergoing gastrectomy.
Low muscle mass, assessed by L3 CT-scan, affects almost 1/3 of GC patients at diagnosis and acts as a negative prognostic marker on many clinical outcomes. Therefore, identifying GC patients with low muscle mass at diagnosis or at follow-up visit should be recommendable. Clinical nutritionists should be part of tumor boards meetings to screen low muscle mass in order to prompt personalized nutritional support.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>31718876</pmid><doi>10.1016/j.clnu.2019.10.021</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-9165-2367</orcidid></addata></record> |
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| ispartof | Clinical nutrition (Edinburgh, Scotland), 2020-07, Vol.39 (7), p.2045-2054 |
| issn | 0261-5614 1532-1983 |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Disease-related malnutrition Gastric cancer Muscle mass Personalised medicine Sarcopenia Tumor boards |
| title | Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis |
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