肌肉衰减症在胰腺癌患者的患病率及其对临床结局影响的系统综述和Meta分析

Prevalence of sarcopenia among patients with pancreatic cancer and its effect on clinical outcomes:a systematic review and meta-analysis

目的:探讨肌肉衰减症在胰腺癌患者中的患病率及其对临床结局的影响。方法:检索PubMed、Embase和Cochrane数据库自建库至2020年10月26日的关于肌肉衰减症在胰腺癌患者的患病率及其对临床结局影响的研究。按纳入和排除标准筛选文献,并采用NOS量表(Newcastle-Ottawa Scale)评价文献质量。首要结局指标为总体生存期;次要结局指标包括胰瘘、重大并发症和总体并发症发生率、术后30 d内死亡及住院时间等。结果:共纳入18项高质量队列研究(亚洲12篇、欧洲1篇、北美洲5篇),共计4346例研究对象。肌肉衰减症以身高校正的第三腰椎平面骨骼肌指数、双侧腰大肌面积指数,或身高校正的四肢骨骼肌指数进行诊断。胰腺癌患者肌肉衰减症的平均患病率为42%(95%CI=32%~53%)。与非肌肉衰减症比较,肌肉衰减症患者总体生存期缩短(HR=1.62,95%CI=1.34~1.95,P<0.01)。胰瘘(RR=0.86,95%CI=0.58~1.28,P=0.459),住院时长(标准化均值差=0.02,95%CI=-0.12~0.16,P=0.743),重大并发症(RR=0.95,95%CI=0.79~1.15,P=0.604),术后30 d死亡发生率(RR=1.39,95%CI=0.42~4.59,P=0.590),总体并发症发生率(RR=1.00,95%CI=0.88~1.12,P=0.962)在肌肉衰减症组和非肌肉衰减症组发生率差异无统计学意义。结论:胰腺癌患者肌肉衰减症患病率较高。伴肌肉衰减症的胰腺癌患者的总体生存期缩短。

Objective To explore the prevalence of sarcopenia and its impact on clinical outcomes among patients with pancreatic cancer.Methods PubMed,Embase and Cochrane were searched for studies focused on prevalence of sarcopenia and its impact on clinical outcomes in pancreatic cancer patients since database inception to Oct.26,2020.The studies were selected according to inclusion and exclusion criteria and assessed for quality using Newcastle-Ottawa Scale.The primary outcome was overall survival,and the secondary outcomes were postoperative pancreatic fistula(POPF),major and overall complication incidence,post-operative 30-day mortality and duration of post-operative hospital stay.Results A total of 18 studies from Asia(n=12),Europe(n=1)and North America(n=5)with 4346 participants were included.Sarcopenia was diagnosed using height-adjusted L3 skeletal muscle index(SMI),total psoas area(TPA),psoas muscle index(PMI)or appendicular skeletal muscle mass(ASM),respectively.The average prevalence of sarcopenia in pancreatic cancer patients was 42%(95%CI:32%-53%).Sarcopenia was significantly associated with lower overall survival(HR=1.62,95%CI:1.34-1.95,P<0.01).There were no significant differences between groups with or without sarcopenia in POPF(RR=0.86,95%CI:0.58-1.28,P=0.459),duration of postoperative hospital stay(SMD=0.02,95%CI:-0.12-0.16,P=0.743),major complications(RR=0.95,95%CI:0.79-1.15,P=0.604),postoperative 30-day mortality(RR=1.39,95%CI:0.42-4.59,P=0.590),and total complications(RR=1.00,95%CI:0.88-1.12,P=0.962).Conclusions The prevalence of sarcopenia was higher in patients with pancreatic cancer.The overall survival of pancreatic cancer patients with sarcopenia is significantly shorter.