The impact of sarcopenia on sarcoma patients: a systematic review and meta-analysis

Purpose: Sarcopenia has been linked to poor outcomes in various cancers, but its specific effect on sarcoma patients remains unclear. This systematic review and meta-analysis investigates the impact of sarcopenia, estimated using CT, on sarcoma patients, focusing on prognostic implications and associated outcomes. Materials and methods: The PubMed, Embase, and SCOPUS databases were searched up to March 2025. Then, a meta-analysis of the data was performed. Overall survival (OS) and relapse-free survival (RFS) were the endpoints. Hazard ratios and 95% confidence intervals were assessed to evaluate the association between sarcopenia and survival of sarcoma patients. Results: Eighteen studies with a total of 1699 patients met the inclusion criteria. Liposarcoma was the most reported histotype in 67% of the studies, with extremities being the most common tumor location (50%), and chemotherapy was the primary intervention in 89% of cases, followed by radiation therapy (78%) and surgery (67%). Analyzing seven articles, a pooled HR of 1.91 (95% CI 1.09-3.34) for OS was reached, indicating that sarcopenic patients have a 91% higher risk of mortality compared to non-sarcopenic patients (p < 0.01). There is no evidence of selective publication (p = 0.137). The meta-analysis for the two studies that reported HR of RFS resulted 1.16 (95% CI 0.85-1.59), not significant (p = 0.28). The quality of the included studies demonstrated high methodological rigor. Conclusions: Worse outcomes have been observed in sarcopenic patients with sarcomas, but the impact of sarcopenia on OS and RFS still remains uncertain, highlighting the need for further research and standardized approaches. Trial Registration The protocol for this review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (registration unique identifying number: CRD42024578969).