SP6.2 The Prognostic Impact of Pre-Treatment Cachexia in Patients Undergoing Resectional Surgery for Oesophagogastric Malignancy: A Systematic Review, Meta-Analysis & Meta-Regression
Leo R Brown, Judith Sayers, Michael Yule, Thomas M. Drake, Stephen J. Wigmore, Richard J.E. Skipworth- Surgery
Abstract
Background
Cancer cachexia is not purely an end-stage phenomenon and even influences the outcome of patients with potentially curative malignancies. This review aims to examine the effect of pre-treatment cachexia on survival in patients undergoing resection of an oesophagogastric malignancy.
Methods
A systematic literature search of MEDLINE, EMBASE and Cochrane Library databases was conducted, from January 2000 to May 2022, to identify studies reporting the influence of pre-treatment weight loss or cachexia on patients undergoing an oesophagogastric resection for cancer with curative intent. Meta-analyses of the primary (overall survival) and secondary (disease-free survival and postoperative mortality) outcomes were performed using random-effects modelling. Meta-regression was used to examine disease stage as a potential confounder.
Results
Ten non-randomised studies, comprising 7186 patients, were eligible for inclusion. The prevalence of pre-treatment cachexia was 35% (95% CI: 24-47%). Pooled adjusted hazard ratios found cachexia to be associated with decreased overall survival (HR 1.46, 95% CI: 1.31-1.60, p<0.001). Meta-analysis of proportions confirmed decreased overall survival at 1-, 3- and 5-years in weight-losing cohorts. Pre-treatment cachexia was not a predictor of disease-free survival and further data are required to establish its influence on postoperative mortality. The proportion of patients with T3/4 tumours was a significant moderator of between-study heterogeneity (p=0.018). Cachexia appeared to have a greater effect on overall survival in studies with a higher proportion of locally advanced tumours.
Conclusions
Pre-treatment cachexia adversely influences overall survival following resection of an oesophagogastric malignancy. Consideration of weight loss, during the shared decision-making process, may improve risk-stratification and facilitate targeted interventions.