Title : Computed tomography-defined osteosarcopenia is a predictor of prognosis in cancer: A meta-analysis and systematic review
Abstract:
Background: Osteosarcopenia is defined as the coexistence of sarcopenia and osteopenia/osteoporosis. The adverse health outcomes associated with osteosarcopenia may be more severe than those observed in individuals with either osteopenia or sarcopenia alone. The aims of this systematic review and meta-analysis were to estimate the prevalence and prognostic value of osteosarcopenia in patients with cancer.
Methods: Four electronic databases including Embase, PubMed, MEDLINE, and Cochrane Library databases were searched to until July 1, 2025 to identify studies related to osteosarcopenia and cancer. Overall pooled prevalence of osteosarcopenia was obtained using a random-effects model. The predictive value of osteosarcopenia for Overall Survival (OS), Disease-Free Survival (DFS), Recurrence-Free Survival (RFS), and Progression-Free Survival (PFS) was also investigated. The meta-analysis on the association between osteosarcopenia and postoperative complications was also conducted. The Quality in Prognosis Studies tool was used to evaluate the quality of the included studies.
Results: A total of 17 studies comprising 3,150 patients were included. Using computed tomography to diagnose osteosarcopenia, the pooled prevalence of osteosarcopenia was 30% (95% Confidence Interval [CI] 25-35%, I2=90.7%) in the studies included for meta-analysis. Osteosarcopenia predicted significantly poor OS (Hazard Ratio [HR]=2.42, 95% CI 2.13-2.75, P<0.001) and DFS/RFS/PFS (HR=2.24, 95% CI 1.89-2.65, P<0.001).
Osteosarcopenia was associated with postoperative complications (Odds Ratio [OR]=1.56, 95% CI 1.31-1.86, P<0.001). Patients with osteosarcopenia had lower body mass index and higher ECOG Performance Status scores than patients without osteosarcopenia. No significant difference in gender was observed between two groups.
Conclusions: The prevalence of osteosarcopenia was high in patients with cancer, especially among the elderly. Our findings demonstrated that osteosarcopenia predicted adverse survival outcomes in elderly patients with cancer.
