Sarcopenic Obesity in Cancer Patients: A Comprehensive Review of Prevalence, Clinical Impact, and Therapeutic Implications

Sarcopenic obesity (SO) is a clinical entity characterized by the coexistence of low muscle mass (sarcopenia) and excess fat mass (obesity). In cancer populations, this condition is often overlooked, as it is masked by a normal or elevated body mass index (BMI). This literature review synthesizes current data on the prevalence, prognostic implications, and potential mechanisms of SO in oncology. The average prevalence of SO is approximately 9.3% (range: 2.3–14.6%) in patients with solid tumors and reaches 24.7% in obese patients (BMI ≥ 30 kg/m²). SO is independently associated with reduced survival, an increased risk of postoperative complications, and dose-limiting toxicity from systemic chemotherapy. Assessment by computed tomography (CT) at the level of the third lumbar vertebra (L3) is the gold standard for diagnosis. Despite growing evidence, standardized diagnostic criteria and specific management strategies are still lacking. Pharmacokinetic studies and dose-modulation trials based on lean body mass are needed to optimize treatment safety and efficacy in these high-risk patients.