Prevalence and prognostic value of sarcopenic obesity in patients with cancer: A systematic review and meta-analysis

The aim of this study was to conduct a systematic review and meta-analysis of observational studies to estimate the overall prevalence and prognostic value of sarcopenic obesity (SO) in patients with cancer. We searched PubMed, Embase, Web of Science and the Cochrane Library for observational studies reporting the prevalence of SO and its prognosis in patients with cancer from inception to December 2020. The pooled prevalence, hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) of data extracted from the studies were calculated. We included 10 004 patients with cancer from 38 studies. The pooled prevalence of SO in this group of patients was 20% (95% CI, 17%-24%). Meta-analysis showed SO was significantly associated with poor overall survival (HR, 1.83; 95% CI, 1.41-2.38), recurrence-free survival (HR, 2.10; 95% CI, 1.57-2.80), disease-free survival (HR, 1.94; 95% CI, 1.01-3.74), postoperative complications (OR, 3.01; 95% CI, 2.08-4.33), and prolonged hospital length of stay (OR, 5.69; 95% CI, 2.76-11.74). The results for the relationship between SO and chemotherapy toxicity were inconsistent and controversial. Current limited evidence suggested that SO may be associated with poor cancer-specific survival (HR, 5.00; 95% CI, 1.40-16.70), but not progression-free survival (HR, 0.61; 95% CI, 0.32-1.16). The present review indicated SO is common in patients with cancer and is significantly associated with several poor outcomes. Therefore, it is necessary to diagnose and screen for SO in patients with cancer in the future, and appropriate interventions should be further explored to improve the prognosis of cancer patients.