Tiezhu Ren, Yue Peng, Long Ma, Qianqian Chen, Yunhang Jing, Yuan Xu, Jiachen Sun, Xinan Su, Wenjuan Zhang, Junlin Zhou
CT-derived sarcopenia, defined by SMI, is an independent risk factor associated with increased POCs in GC patients. However, variability in measurement methods and outcome definitions limits the strength and clinical applicability of current evidence. Future studies should standardize BC assessment and reporting to better guide surgical risk stratification.
BACKGROUND: Predicting postoperative complications (POCs) in gastric cancer (GC) patients is increasingly important in clinical practice. Computed tomography (CT)-derived body composition (BC) parameters, reflecting nutritional and physiological status, have emerged as potential prognostic indicators. This systematic review and meta-analysis aimed to evaluate the association between preoperative muscle and fat parameters and POCs in GC patients.
METHODS: A comprehensive search of PubMed, Web of Science, and Embase was conducted up to December 31, 2024. Two reviewers independently selected studies, extracted data, and assessed quality using the Quality in Prognosis Studies tool. This review specifically focused on studies that evaluated CT-derived BC parameters as independent prognostic factors through multivariable analyses. The primary outcome was the incidence of POCs within 30 days of radical gastrectomy. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model for parameters where quantitative synthesis was feasible.
RESULTS: Out of 4736 identified records, 21 studies were included. All included studies provided adjusted effect estimates for BC parameters from multivariable analyses. Eight BC measures were assessed, including three muscle-related, two fat-related, and three composite metrics. Only sarcopenia defined by skeletal muscle index (SMI) met the criteria for meta-analysis. Pooled analysis of these adjusted estimates confirmed that sarcopenia was significantly and independently associated with POCs (RR = 2.73, 95% CI: 1.83-4.08, P = 0.010, I2 = 66%).
CONCLUSIONS: CT-derived sarcopenia, defined by SMI, is an independent risk factor associated with increased POCs in GC patients. However, variability in measurement methods and outcome definitions limits the strength and clinical applicability of current evidence. Future studies should standardize BC assessment and reporting to better guide surgical risk stratification.