Low skeletal muscle mass is a predictor of treatment related toxicity in oncologic patients. A meta-analysis

Surov, Alexey; Pech, Maciej; Geßner, Daniel; Mikusko, Martin; Fischer, Thomas; Alter, Mareike; Wienke, Andreas

doi:10.1016/j.clnu.2021.08.023

Cited by 43 publications

(44 citation statements)

References 81 publications

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“… 78 , 79 , 80 A 2021 meta‐analysis of 48 studies reported that patients with cancer with low muscle mass had two times greater odds of developing treatment toxicity. 6 In spite of the limited number of studies, our findings suggest that supplementation with HMB/Arg/Gln had a beneficial impact on the incidence of some side effects such as dermatitis, oral mucositis, hand–foot skin reactions, and diarrhoea. 46 , 48 , 52 Potential beneficial effects of HMB supplementation in surgical complications were only observed in studies providing both preoperative and postoperative HMB supplementation (rather than preoperatively alone), although the number of studies was small.…”

Section: Discussionmentioning

confidence: 66%

“… 1 , 2 , 3 , 4 , 5 Low muscle mass has been consistently associated with adverse clinical outcomes, such as greater mortality, dose‐limiting toxicity, length of hospitalization, and postoperative complications. 2 , 3 , 6 , 7 , 8 , 9 Quality of life is also affected following cancer diagnosis and is positively associated with muscle mass. 10 , 11 , 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

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Effects of β‐hydroxy β‐methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review

Prado

Orsso

Pereira

et al. 2022

J cachexia sarcopenia muscle

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Low muscle mass is prevalent among patients with cancer and a predictor of adverse clinical outcomes. To counteract muscle loss, β-hydroxy β-methylbutyrate (HMB) supplementation has been proposed as a potential therapy for older adults and various diseases states. This systematic review aimed to investigate the effects and safety of HMB supplementation in relation to muscle mass and function and other clinical outcomes in patients with cancer. A systematic search of MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, and grey literature for reports published from inception to December 2021 was conducted. Included studies provided supplements containing any dose of HMB to adult patients with active cancer. A synthesis without meta-analysis was conducted using a vote-counting approach based solely on the direction of the effect (i.e. regardless of statistical significance). Risk of bias was assessed for each outcome domain, and evidence from higher-quality studies (i.e. those with either low or moderate risk of bias) was examined. Safety was evaluated using both lower-quality and higher-quality studies. Fifteen studies were included, in which six were randomized controlled trials in patients with various cancer types and treatments. Studies prescribed HMB combined with amino acids (73.3%), HMB in oral nutritional supplements (20.0%), or both supplement types (6.7%); Ca-HMB doses of 3.0 g/day were provided in 80.0% of the studies. Four studies had high risk of bias across all outcome domains. Considering the higher-quality studies, evidence of a beneficial effect of HMB supplementation was found in four of four studies for muscle mass, two of two for muscle function, three of three for hospitalization, and five of seven for survival. In contrast, no beneficial effects of HMB on quality of life or body weight was found in two of four and three of five studies, respectively. A limited number of higher-quality studies evaluating the impact of HMB on cancer therapy-related toxicity, inflammation, and tumour response were observed. No serious adverse effects directly related to the nutrition intervention were reported. Although limited, current evidence suggests that HMB supplementation has a beneficial effect on muscle mass and function in patients with cancer. Well-designed trials are needed to further explore the clinical benefit of HMB supplementation in this patient population.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Effects of β‐hydroxy β‐methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review

Prado

Orsso

Pereira

et al. 2022

J cachexia sarcopenia muscle

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show abstract

“…The abovementioned AEs can influence the patients’ quality of life and can often lead to a termination of the anticancer therapy [ 36 ]. The previous study has shown that sarcopenia is correlated with treatment-related toxicity [ 37 ] and survival [ 38 ] in various malignancies. Nevertheless, the present study has not observed a correlation between treatment outcome and sarcopenia or frailty status.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors

Chang

Peng

et al. 2022

JPM

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This study aimed to access the predictive value of inflammatory indices and clinical factors in toxicity and survival in patients with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma receiving first-line tyrosine kinase inhibitor (TKI)-treatment. A total of 259 patients with stage IIIB–IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI treatment between 2008 and 2020 were retrospectively enrolled and analyzed. The prognostic factors of TKI-related toxicity, overall survival (OS), and progression-free survival (PFS) were identified by using logistic regression analysis and Cox proportional hazards models. Pre-TKI high platelet-to-lymphocyte ratio (PLR) was associated with post-TKI anemia. Hypoalbuminemia was associated with acneiform rash. Elderly age (≥70 years) and lower body mass index (<18.5 kg/m2) were also associated with hypoalbuminemia. Elderly age, stage IV, EGFR-mutated with L858R and uncommon mutations, and neutrophil-to-lymphocyte ratio were found to be independent prognostic factors for PFS, while elderly age, uncommon EGFR-related mutations, and lymphocyte-to-monocyte ratio were found to be independent prognostic factors for OS. A useful prognostic scoring tool for improving the survival risk stratification of patients was established by incorporating the above essential factors. Baseline hypoalbuminemia and PLR could be crucial clinical assessment factors when initiating TKI therapy. In addition, the optimization of individualized treatment strategies for these patients may be assisted by using the risk-scoring model.

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“…LSMM has been associated with poorer survival in malignancies such as gastric and esophageal cancer, colorectal cancer, pancreatic cancer, and lymphoma, among others [3][4][5][6][7]. It has also been associated with dose-limiting toxicity (DLT) and with higher rates of cardiac and pulmonary complications in oncologic patients [8,9]. For post-operative outcomes, a negative influence for post-operative LSMM has been shown for extrahepatic cancer entities [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis

Thormann

Omari

Pech

et al. 2022

Langenbecks Arch Surg

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Purpose To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection. Methods MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument. Results The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis. Conclusion LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC.

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Low skeletal muscle mass is a predictor of treatment related toxicity in oncologic patients. A meta-analysis

Cited by 43 publications

References 81 publications

Effects of β‐hydroxy β‐methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review

Effects of β‐hydroxy β‐methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review

Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors

Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis

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