背景:关于新辅助治疗(NAT)期间骨骼肌萎缩(SMW)的严重程度及其对食管或食管胃交界处癌(EC/EGJC)患者治疗结果的影响存在相当多的争议。本系统综述和荟萃分析旨在解决这些问题。特别是,将NAT期间SMW的预后价值与NAT前和手术前肌少症状态进行比较.
方法:我们搜索了PubMed,Embase,和Cochrane图书馆数据库到10月13日,2021年确定队列研究,重点关注NAT期间的SMW和EC/EGJC患者的治疗结果。研究了新辅助化疗和新辅助放化疗。进行了一项荟萃分析,以量化NAT期间SMW和肌肉减少症的增加。治疗结果包括围手术期发病率和生存情况。同时进行了一项单独的荟萃分析,以调查NAT前/手术前肌少症对治疗结果的影响。
结果:本综述纳入了25项2706名参与者的研究。NAT期间合并的SMW在骨骼肌指数中为-2.47cm2/m2,在腰大肌指数中为-0.23cm2/m2,浪费比例达到4.44%。合并的肌少症患病率从NAT前的53.1%增加到手术前的65.8%。新辅助放化疗,高龄,男性被确定为NAT期间严重SMW的危险因素。值得注意的是,在预测总生存期(HR1.92,P<0.001;HR1.17,P=0.036;和HR1.28,P=0.011)和无复发生存期(HR1.51,P=0.002;HR1.27,P=0.008;和HR1.38,P=0.006)方面,NAT期间的重度SMW的风险比(HR)高于NAT前和手术前肌肉减少症.然而,NAT期间的重度SMW与围手术期发病率无显著相关.
结论:在EC/EGJC患者中,NAT期间的SMW是一种新的预测因子,与肌肉减少症不同。旨在在NAT期间维持骨骼肌的干预措施有望促进治疗结果。
BACKGROUND: Considerable controversies exist regarding the severity of skeletal muscle wasting (SMW) during neoadjuvant therapy (NAT) and its impact on therapeutic outcomes in patients with esophageal or esophagogastric junction cancer (EC/EGJC). This systematic
review and meta-analysis aimed to resolve these issues. Particularly, the prognostic value of SMW during NAT was compared to pre-NAT and pre-surgery sarcopenia status.
METHODS: We searched PubMed, Embase, and Cochrane Library databases through October 13th, 2021 to identify cohort studies focusing on SMW during NAT and therapeutic outcomes in EC/EGJC patients. Both neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy were studied. A meta-analysis was conducted to quantify SMW and increased sarcopenia during NAT. Therapeutic outcomes include perioperative morbidities and survival profiles. A separate meta-analysis investigating the impacts of pre-NAT/pre-surgery sarcopenia on therapeutic outcomes was synchronously performed.
RESULTS: Twenty-five studies with 2706 participants were included in this
review. The pooled SMW during NAT were -2.47 cm2/m2 in skeletal muscle index and -0.23 cm2/m2 in psoas muscle index, with wasting proportion reaching 4.44%. The pooled prevalence rate of sarcopenia increased from 53.1% before NAT to 65.8% before surgery. Neoadjuvant chemoradiotherapy, advanced age, and being male were identified as risk factors for severe SMW during NAT. Notably, severe SMW during NAT showed a greater hazard ratio (HR) than pre-NAT and pre-surgery sarcopenia in predicting overall survival (HR 1.92, P < 0.001; HR 1.17, P = 0.036; and HR 1.28, P = 0.011, respectively) and recurrence-free survival (HR 1.51, P = 0.002; HR 1.27, P = 0.008; and HR 1.38, P = 0.006, respectively). However, severe SMW during NAT was not significantly associated with perioperative morbidities.
CONCLUSIONS: SMW during NAT is a novel prognosticator that is different from sarcopenia for poor survival in EC/EGJC patients. Interventions aiming at maintaining skeletal muscle during NAT are anticipated to promote therapeutic outcomes.