Sarcopenia’s Prognostic Impact on Patients Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Abstract

Background: Although sarcopenia has been reported to predict survival in cancer patients, its impact on patients who received immune checkpoint inhibitors (ICIs) has not been thoroughly investigated. This systematic review aimed to assess the long-term oncologic impact of sarcopenia on patients who received ICIs. Methods: A systematic review of studies indexed in the PubMed, Embase, and Cochrane databases, up to April 1, 2021, was conducted. Studies that reported hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) based on sarcopenia in patients treated with ICIs were included. The inverse variance method was used with a random-effects model for data analysis. Results: A total of 1284 patients from 14 studies were included. Among the patients who received ICIs, patients with sarcopenia had a significant increase in overall mortality compared to patients without sarcopenia in univariate analyses (HR = 1.66, 95% CI = 1.20–2.29, p = 0.002) and in adjusted HRs (HR = 1.55, 95% CI = 1.15–2.10, p = 0.004). The same results were obtained for PFS by both univariate analysis (HR = 1.75, 95% CI = 1.37–2.23, p < 0.001) and adjusted HRs (HR = 1.63, 95% CI 1.28–2.09, p < 0.001). Conclusions: Sarcopenia appears to be an effective biomarker for predicting long-term oncologic outcomes in patients receiving ICI therapy and hence plays an important role when making treatment decisions. However, the fundamental role of this association with survival should be further investigated in large cohorts and clinical trials.

Impact of sarcopenia on the prognosis and treatment of lung cancer: an umbrella review

“…Nearly all reviews (except for one [ 16 ]) were published after 2019. The research team of eight [ 18 , 20 – 25 , 27 ] reviews was based in Asian countries, five [ 16 , 17 , 26 , 28 , 29 ] in European countries, and one [ 19 ] in the United States of America. Eight [ 16 – 21 , 24 , 29 ] reviews focused on malignancies of pulmonary origin, with four [ 18 , 21 , 24 , 29 ] solely examining NSCLC and four [ 16 , 17 , 19 , 20 ] encompassing all lung cancers.…”

“…Eight [ 16 – 21 , 24 , 29 ] reviews focused on malignancies of pulmonary origin, with four [ 18 , 21 , 24 , 29 ] solely examining NSCLC and four [ 16 , 17 , 19 , 20 ] encompassing all lung cancers. The remaining six [ 22 , 23 , 25 – 28 ] reviews incorporated tumors from multiple locations and dedicated a portion to lung cancer. The majority of reviews revealed the impact of sarcopenia on short-and long-term outcomes in the lung cancer population.…”

“…Two [ 16 , 29 ] focused on the broad scope of nutritional status evaluation, and two [ 26 , 28 ] were centered on the prevalence of sarcopenia. Meta-analyses were conducted in eleven publications [ 17 – 25 , 27 , 28 ]. The characteristics of the included reviews are outlined in Table 1 .…”

“…According to the critical appraisal using AMSTAR2, one review [ 20 ] had high, nine had low [ 17 , 18 , 21 – 23 , 25 , 27 – 29 ], and four [ 16 , 17 , 19 , 24 , 26 ] had critically low evidence quality. Common methodological problems were lack of prior protocol registration (only registered in two reviews [ 27 , 29 ]), not employing a comprehensive search strategy (three reviews [ 19 , 24 , 26 ] used only PubMed for literature search and 12 [ 16 – 19 , 22 – 29 ] did not consider trial registries), and not providing sufficient information on the excluded studies (only recorded in three reviews [ 16 , 20 , 25 ]). Seven reviews [ 18 , 19 , 22 – 24 , 26 , 28 ] did not elaborate on duplicate study selection, and seven [ 16 , 17 , 22 , 23 , 26 – 28 ] did not show independent data extraction by two authors.…”

“…Four reviews [ 17 , 20 , 22 , 29 ] incorporated diverse treatment options, such as surgery, chemotherapy, immunotherapy, radiotherapy, or palliative care. Three reviews [ 18 , 19 , 24 ] emphasized on the postoperative outcomes and four [ 21 , 23 , 25 , 27 ] focused on immunotherapy.…”