Clinical significance of sarcopenia in the treatment of patients with primary hepatic malignancies, a systematic review and meta-analysis

Guoqing Zhang, Songfeng Meng, Renfeng Li, Jianwen Ye, Longshuan Zhao, Guoqing Zhang, Songfeng Meng, Renfeng Li, Jianwen Ye, Longshuan Zhao

Abstract

Background: The impact of sarcopenia on outcomes following treatment for primary liver tumors remains contentious. Therefore, we performed a systematic literature review and meta-analysis to evaluate the clinical significance of sarcopenia in the treatment of patients with primary liver tumors.

Data sources: A systematic literature search was performed in English through February 1, 2017 in databases.

Results: There were significant differences between patients with and without sarcopenia in overall 1- and 3-year survival (1 year: OR: 0.43; 95% CI: 0.27-0.68; P=0.0004; 3 year: OR: 0.67; 95% CI: 0.47-0.96; P=0.03). However, overall 5-year survival showed no significant difference between the groups (OR: 0.61; 95% CI: 0.35-1.07; P=0.08). Patients with sarcopenia showed a significant 53% reduction in disease-free survival within 5 years (OR: 0.47; 95% CI: 0.28-0.79; P=0.005). Also, sarcopenia had a significantly negative impact on recurrence in patients with primary liver tumors (RR: 2.71; 95% CI: 1.46-5.05; P=0.002). Regarding complications rate, we concluded that there was a statistically significant difference between two groups in overall complications rate (RR: 2.52; 95% CI: 1.50-4.22; P=0.0005). However, the major complications rate showed no significant difference between the groups (RR: 1.19; 95% CI: 0.65-2.20; P=0.57).

Conclusions: Sarcopenia seemed to have a negative effect on overall survival in patients with primary liver tumors in the early phase post-treatment, but further research is needed to investigate the prognostic impact on overall survival over the longer term. Moreover, sarcopenia could significantly increase the incidence rates of post-treatment recurrence and overall complications in patients with primary liver tumors.

Keywords: hepatocellular carcinoma; intrahepatic cholangio-carcinoma; sarcopenia; third lumbar skeletal muscle index; third lumbar total psoas area.

Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no conflicts of interest.

Figures

Figure 1. PRISMA 2009 Flow Diagram
Figure 1. PRISMA 2009 Flow Diagram
Figure 2. Meta-analysis of the overall 1-,…
Figure 2. Meta-analysis of the overall 1-, 3- and 5-year survival
(a) Overall 1-year survival. (b) overall 3-year survival. (c) overall 5-year survival.
Figure 3. Meta-analysis of the 1-, 3-…
Figure 3. Meta-analysis of the 1-, 3- and 5-year disease-free survival
(a) 1-year disease-free survival. (b) 3-year disease-free survival. (c) 5-year disease-free survival.
Figure 4. Meta-analysis of the recurrence rate
Figure 4. Meta-analysis of the recurrence rate
Figure 5. Meta-analysis of the post-treatment complication…
Figure 5. Meta-analysis of the post-treatment complication rate
(a) Overall complication. (b) major complication.

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