Sarcopenia as a predictor of postoperative outcomes after urologic oncology surgery: A systematic review and meta-analysis

Aim: Sarcopenia as a reliable prognostic predictor in urologic oncology surgery remains controversial, and no consensus amongst researchers exists regarding the management of patients with sarcopenia. This meta-analysis was conducted to investigate the association between sarcopenia and postoperative outcomes after urologic oncology surgery. Methods: A systematic search in MEDLINE (via PubMed), Embase, Web of Science and Cochrane Library databases was conducted to identify the potential studies published before August 2019. Odds ratios and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated through inverse variance with random or fixed effects models. Results: Seventeen retrospective cohorts comprising 3,948 patients were included with sarcopenia prevalence between 25% and 68.9%. Patients with sarcopenia had significantly shorter overall survival (OS; HR = 2.06, 95% CI: 1.44-2.95; P < 0.001; I-square (I-2) = 86%) and cancer-specific survival (HR = 2.16, 95% CI: 1.60-2.92; P < 0.001; I-2 = 49.4%) than those without sarcopenia. Sarcopenia was independently associated with increased all-cause mortality (HR = 1.50, 95% CI: 1.26-1.80; P < 0.001; I-2 = 0%) and cancer-specific mortality (HR = 1.50, 95% CI: 1.12-2.01; P = 0.006; I-2 = 0%). No prognostic difference was observed in the postoperative risk of total complications and systemic progression except lymphovascular invasion status. Conclusions: Sarcopenia is an independent poor prognostic factor for patients undergoing urologic oncology surgery, particularly postoperative risks of short survival and increased mortality. Thus, preoperative sarcopenia evaluation can provide clinicians with important information to guide and individualise patient management and improve surgical outcomes. (C) 2020 Elsevier Inc. All rights reserved.