Sarcopenia and survival in surgically treated non-small cell lung cancer: A systematic review and meta-analysis

OBJECTIVES: Lung cancer is the leading cause of cancer-related death. Early-stage non-small cell lung cancer (NSCLC) patients can be eligible for surgical resection. Sarcopenia has emerged as a negative prognostic factor for overall survival across various cancer types. The aim of this systematic review and meta-analysis was to systematically evaluate the association between CT-derived sarcopenia and overall survival in NSCLC patients undergoing surgical treatment. METHODS: A comprehensive systematic literature search was conducted in PubMed, Embase, Scopus, and Cochrane. Studies evaluating the association between CT-derived sarcopenia and overall survival among surgically treated NSCLC patients were included. RESULTS: Studies (N = 5707) were screened for eligibility, and 27 studies with a total of 12,011 patients met the inclusion criteria. Risk of bias analysis revealed highly selective study populations and substantial heterogeneity in the definition and measurement of sarcopenia. The pooled hazard ratio for overall survival, based on data from 21 of the 27 included studies, was 1.99 (95 % confidence interval 1.73-2.28) for sarcopenic patients vs. non-sarcopenic patients with a 95 % prediction interval between 1.26 and 3.12. For patients with pathological stage I-II disease, the hazard ratio was 2.33 (95 % CI 1.91-2.83) with a 95 % prediction interval between 1.84 and 2.95. CONCLUSIONS: The included studies exhibited methodological variations, particularly in study population and definition of sarcopenia. There was an association between sarcopenia and reduced overall survival in the surgically treated NSCLC population, with an even stronger association observed in early pathological stages. This highlights a potential value of incorporating assessments of muscle mass into the management of NSCLC.