Supportive Therapy in OncologySupportive Therapy in OncologyПоддерживающая терапия в онкологии3034-24733034-3178Publishing House ABV Press3710.17650/3034-2473-2024-1-3-26-48REVIEWSОБЗОРНЫЕ СТАТЬИEffect of sarcopenic obesity on treatment results in patients with malignant tumors of the gastrointestinal tract: systematic reviewВлияние саркопенического ожирения на результаты лечения пациентов со злокачественными опухолями желудочно-кишечного тракта: систематический обзорhttps://orcid.org/0000-0003-4174-6637BoldyrevaT. S.БолдыреваТ. С.
Russian Federation

Tatyana Sergeevna Boldyreva

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Татьяна Сергеевна Болдырева

117152 Москва, Загородное шоссе, 18А, стр. 7

dikovatatyanasergeevna@gmail.comhttps://orcid.org/0000-0002-7281-3591LyadovV. K.ЛядовВ. К.
Russian Federation

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Build. 1, 2/1 Barrikadnaya St., Moscow 125993

5 Stroiteley Prospekt, Novokuznetsk 654005

117152 Москва, Загородное шоссе, 18А, стр. 7

125993 Москва, ул. Баррикадная, 2/1, стр. 1

654005 Новокузнецк, пр-кт Строителей, 5

S.S. Yudin City Clinical Hospital, Moscow Healthcare DepartmentГБУЗ г. Москвы «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения г. Москвы»Department of Oncology and Palliative Medicine named after acad. I.A. Savitsky, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russiaкафедра онкологии и паллиативной медицины им. акад. И.А. Савицкого ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииNovokuznetsk State Institute for Postgraduate Medical Education – branch of the Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaНовокузнецкий государственный институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России151220241326482201202522012025Copyright ©; 2024, Boldyreva T.S., Lyadov V.K.Copyright ©; 2024, Болдырева Т.С., Лядов В.К.2024Boldyreva T.S., Lyadov V.K.Болдырева Т.С., Лядов В.К.https://creativecommons.org/licenses/by/4.0https://stio.abvpress.ru/jour/article/view/37

Background. Tumors of the gastrointestinal (GI) tract are characterized by high morbidity and poor prognosis. Over the past decade, sarcopenia (skeletal muscle depletion), myosteatosis, sarcopenic obesity were all shown to have negative prognostic effect in patients with various GI malignancies. However, the role of sarcopenic obesity (SO) in patients with GI tumors remains controversial. We have summarized clinical trial data on the effect of SO on treatment results in patients with malignant GI tumors who underwent surgical and/or drug antitumor treatment.

Materials and methods. Thisstudy was conducted in comliance with the Preferred Reporting Itemsfor Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched for relevant original studies published between January 2009 and December 2022 reporting postoperative complication rate and mortality, long-term survival and chemotherapy toxicity in SO patients with GI cancers.

Results. Twenty four studies with 9,601 patients were included. The percentage of SO patients ranged from 2.6 to 51 %. Due to significant heterogeneity of SO determination methods and varying threshold values, the association between SO and outcomes of interest was inconsistent. SO was significantly associated with development of major postoperative complications in six studies. In contrast, three studies did not show any effect of SO on postoperative complications. Only two studies demonstrated that the mortality rate was significantly higher among patients with SO compared to those without SO. Four studies using multivariate analysis showed statistically significant effect of SO on long-term survival, one study – on disease-free survival. However, three trials contradicted this finding and reported that SO was not a negative prognostic factor of long-term survival in GI cancer patients. Three studies investigating SO effect on the outcomes of drug antitumor treatment showed negative effect of SO on chemotherapy toxicity.

Conclusion. There is considerable heterogeneity in methods used to define SO in the literature, and current data is limited. Standardized terminology and deeper understanding of sarcopenic obesity pathophysiology is needed to further understand the effect of obesity and sarcopenia on clinical trajectory of patients with GI cancer.

Введение. Опухоли желудочно-кишечного тракта (ЖКТ) характеризуются высокой распространенностью и неблагоприятным прогнозом. За последнее десятилетие показано, что саркопения (истощение скелетной мускулатуры), миостеатоз, саркопеническое ожирение (СО) оказывают отрицательное прогностическое влияние на результаты лечения пациентов с различными злокачественными новообразованиями. Однако роль СО у пациентов с опухолями ЖКТ остается спорной. Мы обобщили данные клинических исследований, посвященных влиянию СО на результаты терапии пациентов со злокачественными новообразованиями ЖКТ, перенесших хирургическое и/или лекарственное противоопухолевое лечение.

Материалы и методы. Мы провели систематический обзор литературы в соответствии с рекомендациями PRISMA. Выполнен поиск оригинальных исследований в базах данных PubMed и Cochrane Library, опубликованных в период с января 2009 г. по декабрь 2022 г., по влиянию СО на частоту послеоперационных осложнений и уровень летальности, а также общую выживаемость и токсичность химиотерапии у пациентов с опухолями ЖКТ.

Результаты. Включено 24 исследования с участием 9601 пациента. Распространенность СО варьировала в пределах 2,6–51 %. Вследствие значительной гетерогенности в отношении методологии определения СО и различных пороговых значений связь между СО и интересующими результатами была противоречивой. В 6 работах СО было связано с возникновением серьезных послеоперационных осложнений. Напротив, в 3 исследованиях не показано влияние СО на частоту послеоперационных осложнений. В 4 работах выявлено неблагоприятное влияние СО на уровень летальности пациентов после оперативного лечения опухолей ЖКТ. В ходе многофакторного анализа в 5 исследованиях выявлено статистически значимое влияние СО на общую выживаемость. Статистически значимая разница между СО и безрецидивной выживаемостью установлена в 1 работе. В 3 исследованиях, посвященных влиянию СО на результаты лекарственного противоопухолевого лечения, показано отрицательное влияние данного феномена на токсичность химиотерапии.

Заключение. В литературе существует гетерогенность в определении СО. Стандартизация методологии и более глубокое понимание патофизиологии СО необходимы для дальнейшего понимания влияния ожирения и саркопении на результаты лечения пациентов с опухолями ЖКТ.

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