Sarcopenia and prognosis of advanced cancer patients receiving immune checkpoint inhibitors: A comprehensive systematic review and meta-analysis.
patients with advanced cancer
receiving immune checkpoint inhibitors (ICIs)
sarcopenia vs. no sarcopenia
response rate, 1-y progression-free survival (PFS) rate, 1-y overall survival (OS) rate, hazard ratios (HRs) of PFS and OS
Abstract
Sarcopenia is commonly encountered in patients with advanced cancer, but the role of sarcopenia in predicting prognosis in this group of patients receiving immune checkpoint inhibitors (ICIs) remains undetermined. The aim of this study was to performed the first meta-analysis focusing on the prognostic value of sarcopenia in patients with advanced cancer who were treated with ICIs comprehensively. A systematic search for relevant studies in the Web of Science, PubMed, and Embase was conducted on August 19, 2020. Outcomes including response rate, 1-y progression-free survival (PFS) rate, 1-y overall survival (OS) rate, and hazard ratios (HRs) of PFS and OS were extracted. Meta-analysis was performed by using the STATA version 12 software package. Nine cohort studies consisting of 740 patients with advanced cancer receiving ICIs were finally included for analysis. Our meta-analysis found that patients with sarcopenia tended to have a lower response rate than those without the disease (30.5 versus 15.9%; P = 0.095). Furthermore, patients with sarcopenia yielded a significantly shorter 1-y PFS rate (32 versus 10.8%; risk ratio [RR], 1.31; P < 0.001) and 1-y OS rate (66 versus 43%; RR, 1.71; P < 0.001) than patients without sarcopenia. Moreover, sarcopenia was found to be an independent, unfavorable prognostic factor of PFS (HR, 1.79; P < 0.001) and OS (HR, 2.11; P < 0.001) in patients with advanced cancer receiving ICIs. Subgroup analysis further confirmed the unfavorable predictive value of sarcopenia in patients with advanced non-small cell lung cancer and those with melanoma receiving ICIs. Sarcopenia proved to be an independent, unfavorable prognostic factor in patients with advanced cancer receiving ICIs. Routine assessment of sarcopenia status and correction of sarcopenic status should be emphasized for patients treated with ICIs. Further research with sufficient adjustments for confounding factors are warranted to better elucidate the prognostic value of sarcopenia in these patients.