Predictive Value of Preoperative Sarcopenia in Patients with Gastric Cancer: a Meta-analysis and Systematic Review

Purpose The impact of preoperative sarcopenia on postoperative complications and overall survival has been recently debated. Our meta-analysis aims to ascertain whether preoperative sarcopenia increases the risk of poor outcomes and to attempt to provide new ideas for the prognosis of outcomes for patients with gastric cancer. Methods We searched for all relevant articles on PubMed, the EMBASE database, and Web of Science (up to September 1, 2017). Data synthesis and statistical analysis were carried out using RevMan 5.3 software. Results Thirteen studies involving 4262 patients who underwent gastrectomy for gastric cancer were analyzed (sarcopenia group=1234; non-sarcopenia group=3028). The results showed that preoperative sarcopenia significantly associated with poor pathological staging (high pT: OR=1.86, 95% CI=1.49-2.31; P<0.01; pN+: OR=1.61, 95% CI=1.33-1.94; P<0.01; high TNM category: OR=1.84, 95% CI=1.53-2.22; P<0.01). Patients with preoperative sarcopenia had an increased risk of total postoperative complications (OR=2.17, 95% CI=1.53-3.08; P<0.01), severe complications (OR=1.65, 95% CI=1.09-2.50; P=0.02), and poorer OS (HR=1.70, 95% CI=1.45-1.99; P<0.01). The results of subgroup analyses revealed that patients with preoperative sarcopenia over 65years old and those from Asian populations had higher risks for total postoperative complications and severe complications. Conclusion This meta-analysis reveals that preoperative sarcopenia may be used as a new indicator of poor pathological staging, impaired overall survival, and increased postoperative complications. Notably, patients with gastric cancer who are over 65years old and from Asia should be routinely screened for sarcopenia before surgery to adequately assess the risk of postoperative complications in clinical practice.