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Low muscle mass and treatment tolerance in patients with upper gastrointestinal cancer: a systematic review and meta‐analysis
Stanhope, Edward Thomsen, Simon N. Turner, J.E. Fairman, Ciaran M.
Stanhope, Edward
Thomsen, Simon N.
Turner, J.E.
Fairman, Ciaran M.
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2025-02-17
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Abstract
ABSTRACT Background Upper gastrointestinal (GI) cancers carry notable mortality risks. While systemic therapies are vital for their management, they are often hindered by adverse events (AE), which can compromise their effectiveness. The presence of low skeletal muscle mass (LSMM) may be linked with the prevalence of AE and could potentially undermine treatment tolerance by impacting drug metabolism. The primary objective of this systematic review and meta-analysis was to evaluate the association between LSMM and the risk of grades 3 and 4 AE and treatment discontinuation. Methods Studies investigating the association between skeletal muscle mass and AE or treatment tolerability in adult patients diagnosed with upper GI cancer scheduled to undergo systemic treatment were eligible. The primary outcomes were grades 3 and 4 AE and treatment discontinuations. Four electronic databases were systematically searched with no date restrictions on 10 October 2022. Data were analysed via random-effects meta-analyses, and the risk of bias was assessed using the risk of bias in non-randomised studies—of exposure (ROBINS-E) appraisal tool. Results We identified 50 eligible publications from 49 studies. Our meta-analyses revealed evidence of a higher risk of grades 3 and 4 AE (RR 1.44, 95% CI 1.23–1.68, N = 13) and treatment discontinuation (RR 2.39, 95% CI 1.87–3.07, N = 11) in LSMM versus non-LSMM. Secondary analyses revealed an increased risk of fatigue, febrile neutropenia, intestinal pneumonia, stomatitis and thrombocytopenia in LSMM. However, 92% of studies assessing grades 3 and 4 AE and 73% of studies examining treatment discontinuation had a very high risk of bias. Conclusions LSMM in patients with upper GI cancer is associated with a higher risk of grades 3 and 4 AE and the discontinuation of systemic cancer treatment. The high risk of bias should be considered in the interpretation of these findings. Further evaluation of the association between LSMM and treatment tolerability in confirmatory, prospective studies is needed.
Citation
Stanhope, E.N., Thomsen, S.N., Turner, J.E., Fairman, C.M. and Lahart, I.M. (2025) Low muscle mass and treatment tolerance in patients with upper gastrointestinal cancer: a systematic review and meta‐analysis. JCSM Communications, 8(1), e115.
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Journal article
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en
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© 2025 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link: https://doi.org/10.1002/rco2.115
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2996-1394
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2996-1394
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The Centre for Physical Activity Research (CFAS) is supported by TrygFonden (grants ID 101390, ID 20045 and ID 125132).