Effects of Sarcopenia on Patient Outcomes in Gastrointestinal Cancer: An Umbrella Review of Published Meta-Analyses

BACKGROUND: Gastrointestinal tumors represent a significant proportion of malignant neoplasms worldwide. Sarcopenia has emerged as a clinically relevant prognostic factor. Defined as the progressive and generalized loss of skeletal muscle mass and function, sarcopenia has been associated with adverse outcomes in oncological patients.

METHODS: We conducted an umbrella review of accumulated evidence to evaluate sarcopenia as a risk factor for major complications (Clavien-Dindo ≥ 3) and overall survival in patients with gastrointestinal cancer. A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS: Sixty-three studies were included. Among the 29 studies that reported major complications, 19 studies (65.51%) identified sarcopenia as a risk factor, while the others did not find a statistically significant difference in the overall effect. Strong evidence (Class II) indicated that sarcopenia is associated with an increased risk of major complications (eOR = 1.56, 95% CI 1.40-1.75). Conversely, 56 of the included studies reported overall survival as the primary outcome of interest, with 52 (92.85%) identifying sarcopenia as a risk factor for reduced survival. Strong evidence (Class II) supports that sarcopenia is linked to reduced survival (eOR = 1.79, 95% CI 1.71-1.88).

CONCLUSION: This umbrella review of accumulated evidence demonstrates that sarcopenia is a highly suggestive risk factor for major postoperative complications and reduced overall survival in patients with gastrointestinal tumors. Consequently, the identification of sarcopenia in this patient population should prompt the implementation of preventive and therapeutic interventions aimed at improving clinical outcomes.