1. bookVolume 59 (2021): Issue 4 (December 2021)
Journal Details
First Published
30 Mar 2015
Publication timeframe
4 times per year
access type Open Access

The prevalence and the impact of sarcopenia in digestive cancers. A systematic review

Published Online: 20 Nov 2021
Page range: 328 - 344
Received: 03 May 2021
Journal Details
First Published
30 Mar 2015
Publication timeframe
4 times per year

Introduction: Sarcopenia is characterized by a decrease in skeletal muscle mass, associated with low muscle strength and/or poor physical performance. Assessing the prevalence of sarcopenia among digestive cancers and establishing the impact that sarcopenia has on the postoperative evolution of digestive tumors may be a central pillar in improving postoperative outcomes by caring for perioperative sarcopenia.

This brief review aimed to evaluate the prevalence of sarcopenia in digestive cancer patients.

Method and materials: PubMed database was searched for “sarcopenia” AND “digestive cancers” from January 1st, 2010, through September 30th, 2020. PRISMA guideline was used for this systematic review. After the selection process, 31 complete studies were included in our review.

Assessment of sarcopenia diagnosis for the studies included in this systematic review was based on a computed tomographic calculation of the skeletal muscle index at the third lumbar vertebra.

Results: Among a total of 11,651 patients with digestive cancers, the prevalence of sarcopenia was 43.68%.

The highest prevalence of sarcopenic patients was in esophageal (70.4%) and hepatic (60.3%) cancer, following by biliary tract (49.3%), pancreatic (45.70%), colorectal (42.83%) cancer, and gastric cancer (32.05%) with the lowest prevalence.

The results of the studies conducted by now regarding the prevalence of sarcopenia in digestive cancers and its relevance in the evolution of these cancers are discordant and uneven.

Some studies show that the presence of sarcopenia in patients with digestive cancers is associated with an increased rate of postoperative complications, increased toxicity of chemotherapeutics and increased mortality. Other studies do not find sarcopenia as an independent risk factor associated with negative consequences in the course of patients with digestive cancers.

Conclusions: Sarcopenia is prevalent in digestive cancers. There is still no consensus about the impact of sarcopenia on the treatment of digestive cancers. Further studies are needed to evaluate the real consequences of sarcopenia in digestive cancers..


1. CRUZ-JENTOFT, A.J., BAHAT, G., BAUER, J., BOIRIE, Y., BRUYÈRE, O., CEDERHOLM, T., et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing 2019;48(1):16–31. Search in Google Scholar

2. VON HAEHLING, S., MORLEY, J.E., ANKER, S.D. An overview of sarcopenia: Facts and numbers on prevalence and clinical impact. b.n. Available at: doi:10.1007/s13539-010-0014-2. Search in Google Scholar

3. HEYMSFIELD, S.B., WANG, Z.M., BAUMGARTNER, R.N., ROSS, R. Human body composition: Advances in models and methods. b.n.Available at: doi:10.1146/annurev.nutr.17.1.527. Search in Google Scholar

4. PRADO, C.M., LIEFFERS, J.R., MCCARGAR, L.J., REIMAN, T., SAWYER, M.B., MARTIN, L., et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7). Search in Google Scholar

5. RIER, H.N., JAGER, A., SLEIJFER, S., MAIER, A.B., LEVIN, M. The Prevalence and Prognostic Value of Low Muscle Mass in Cancer Patients: A Review of the Literature. Oncologist 2016;21(11). Search in Google Scholar

6. MALTAIS ML, DESROCHES J, DIONNE IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186–97. https://www.ncbi.nlm.nih.gov/pubmed/19949277. no date. Search in Google Scholar

7. GOODPASTER BH, PARK SW, HARRIS TB, KRITCHEVSKY SB, NEVITT M, SCHWARTZ AV, SIMONSICK EM, TYLAVSKY FA, VISSER M, NEWMAN AB. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A B no date. Search in Google Scholar

8. GALLAGHER D, VISSER M, DE MEERSMAN RE, SEPULVEDA D, BAUMGARTNER RN, PIERSON RN, HARRIS T, HEYMSFIELD SB. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol (1985). 1997;83(1):229–39. no date. Search in Google Scholar

9. https://www.visiblebody.com/learn/skeleton/appendicular-skeleton. Search in Google Scholar

10. NIRMALA RATHNAYAKE, GAYANI ALWIS LEKAMWASAM, J.L. AND S. Concordance between appendicular skeletal muscle mass measured with DXA and estimated with mathematical models in middle-aged women. Rathnayake al. J. Physiol. Anthropol. 3719 https://doi.org/10.1186/s40101-018-0179-5 no date. Search in Google Scholar

11. WANG J, THORNTON JC, KOLESNIK S, PIERSON RN JR. Anthropometry in body composition: an overview. Ann N Y Acad Sci. 2000;904:317–26. https://www.ncbi.nlm.nih.gov/pubmed/10865763. no date. Search in Google Scholar

12. ROLLAND, Y., CZERWINSKI, S., VAN KAN, G.A., MORLEY, J.E., CESARI, M., ONDER, G., et al. Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives. b.n.Available at: doi:10.1007/BF02982704. Search in Google Scholar

13. GROTENHUIS, B.A., SHAPIRO, J., VAN ADRICHEM, S., DE VRIES, M., KOEK, M., WIJNHOVEN, B.P.L., et al. Sarcopenia/Muscle Mass is not a Prognostic Factor for Short- and Long-Term Outcome After Esophagectomy for Cancer. World J. Surg. 2016;40(11). Search in Google Scholar

14. ZHUANG, C. LE, HUANG, D.D., PANG, W.Y., ZHOU, C.J., WANG, S.L., LOU, N., et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: Analysis from a large-scale cohort. Med. (United States) 2016;95(13). Search in Google Scholar

15. MOHER, D., LIBERATI, A., TETZLAFF, J., ALTMAN, D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339(jul21 1):b2535–b2535. Search in Google Scholar

16. CHEN, L.-K., WOO, J., ASSANTACHAI, P., AUYEUNG, T.-W., CHOU, M.-Y., IIJIMA, K., et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J. Am. Med. Dir. Assoc. 2020;21(3):300–307.e2. Search in Google Scholar

17. WELLS, G., SHEA, B., O’CONNELL, D., PETERSON, J., WELCH, V., LOSOS, M., et al. The Newcastle–Ottawa Scale (NOQAS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. The Ottawa Hospital. Search in Google Scholar

18. DIJKSTERHUIS, W.P.M., PRUIJT, M.J., VAN DER WOUDE, S.O., KLAASSEN, R., KURK, S.A., VAN OIJEN, M.G.H., et al. Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy. J. Cachexia. Sarcopenia Muscle 2019;10(1). Search in Google Scholar

19. JÄRVINEN, T., ILONEN, I., KAUPPI, J., VOLMONEN, K., SALO, J., RÄSÄNEN, J. Low skeletal muscle mass in stented esophageal cancer predicts poor survival: A retrospective observational study. Thorac. Cancer 2018;9(11). Search in Google Scholar

20. LEE, J.S., KIM, Y.S., KIM, E.Y., JIN, W. Prognostic significance of CT-determined sarcopenia in patients with advanced gastric cancer. PLoS One 2018;13(8). Search in Google Scholar

21. LIN, J., ZHANG, W., HUANG, Y., CHEN, W., WU, R., CHEN, X., et al. Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: A prospective study. Cancer Manag. Res. 2018;10. Search in Google Scholar

22. CESPEDES FELICIANO, E.M., AVRUTIN, E., CAAN, B.J., BOROIAN, A., MOURTZAKIS, M. Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality. J. Cachexia. Sarcopenia Muscle 2018;9(5):898–908. Search in Google Scholar

23. DOLAN, R.D., ALMASAUDI, A.S., DIEU, L.B., HORGAN, P.G., MCSORLEY, S.T., MCMILLAN, D.C. The relationship between computed tomography-derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer. J. Cachexia. Sarcopenia Muscle 2019;10(1):111–122. Search in Google Scholar

24. XIAO, J., CAAN, B.J., CESPEDES FELICIANO, E.M., MEYERHARDT, J.A., KROENKE, C.H., BARACOS, V.E., et al. The association of medical and demographic characteristics with sarcopenia and low muscle radiodensity in patients with nonmetastatic colorectal cancer. Am. J. Clin. Nutr. 2019;109(3):615–625. Search in Google Scholar

25. VASHI, P.G., GORSUCH, K., WAN, L., HILL, D., BLOCK, C., ID, D.G. Sarcopenia supersedes subjective global assessment as a predictor of survival in colorectal cancer 2019;69:1–14. Search in Google Scholar

26. KURK, S., PEETERS, P., STELLATO, R., DORRESTEIJN, B., DE JONG, P., JOURDAN, M., et al. Skeletal muscle mass loss and dose-limiting toxicities in metastatic colorectal cancer patients. J. Cachexia. Sarcopenia Muscle 2019;10(4). Search in Google Scholar

27. DOLAN, D.R., KNIGHT, K.A., MAGUIRE, S., MOUG, S.J. The relationship between sarcopenia and survival at 1 year in patients having elective colorectal cancer surgery. Tech. Coloproctol. 2019;23(9). Search in Google Scholar

28. BROUGHMAN, J.R., WILLIAMS, G.R., DEAL, A.M., YU, H., NYROP, K.A., ALSTON, S.M., et al. Prevalence of sarcopenia in older patients with colorectal cancer. J. Geriatr. Oncol. 2015;6(6). Search in Google Scholar

29. CHOI, M.H., OH, S.N., LEE, I.K., OH, S.T., WON, D.D. Sarcopenia is negatively associated with long-term outcomes in locally advanced rectal cancer. J. Cachexia. Sarcopenia Muscle 2018;9(1). Search in Google Scholar

30. LIEFFERS, J.R., BATHE, O.F., FASSBENDER, K., WINGET, M., BARACOS, V.E. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br. J. Cancer 2012;107(6). Search in Google Scholar

31. RICHARDS, C.H., ROXBURGH, C.S.D., MACMILLAN, M.T., ISSWIASI, S., ROBERTSON, E.G., GUTHRIE, G.K., et al. The Relationships between Body Composition and the Systemic Inflammatory Response in Patients with Primary Operable Colorectal Cancer. PLoS One 2012;7(8):e41883. Search in Google Scholar

32. TAKEDA, Y., AKIYOSHI, T., MATSUEDA, K., FUKUOKA, H., OGURA, A., MIKI, H., et al. Skeletal muscle loss is an independent negative prognostic factor in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy. PLoS One 2018;13(4):e0195406. Search in Google Scholar

33. ONISHI, S., SHIRAKI, M., NISHIMURA, K., HANAI, T., MORIWAKI, H., SHIMIZU, M. Prevalence of sarcopenia and its relationship with nutritional state and quality of life in patients with digestive diseases. J. Nutr. Sci. Vitaminol. (Tokyo). 2018;64(6). Search in Google Scholar

34. SAKAMOTO, T., YAGYU, T., UCHINAKA, E., MIYATANI, K., HANAKI, T., KIHARA, K., et al. Sarcopenia as a prognostic factor in patients with recurrent pancreatic cancer: A retrospective study. World J. Surg. Oncol. 2020;18(1). Search in Google Scholar

35. NAUMANN, P., EBERLEIN, J., FARNIA, B., HACKERT, T., DEBUS, J., COMBS, S.E. Continued weight loss and sarcopenia predict poor outcomes in locally advanced pancreatic cancer treated with chemoradiation. Cancers (Basel). 2019;11(5). Search in Google Scholar

36. GRUBER, E.S., JOMRICH, G., TAMANDL, D., GNANT, M., SCHINDL, M., SAHORA, K. Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One 2019;14(5). Search in Google Scholar

37. AMRANI, M. EL, VERMERSCH, M., FULBERT, M., PRODEAU, M., LECOLLE, K., HEBBAR, M., et al. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy a retrospective analysis of 107 patients. Med. (United States) 2018;97(39). Search in Google Scholar

38. VAN DIJK, D.P.J., BAKENS, M.J.A.M., COOLSEN, M.M.E., RENSEN, S.S., VAN DAM, R.M., BOURS, M.J.L., et al. Low skeletal muscle radiation attenuation and visceral adiposity are associated with overall survival and surgical site infections in patients with pancreatic cancer. J. Cachexia. Sarcopenia Muscle 2017;8(2). Search in Google Scholar

39. NINOMIYA, G., FUJII, T., YAMADA, S., YABUSAKI, N., SUZUKI, K., IWATA, N., et al. Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study. Int. J. Surg. 2017;39. Search in Google Scholar

40. PENG, P., HYDER, O., FIROOZMAND, A., KNEUERTZ, P., SCHULICK, R.D., HUANG, D., et al. Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma. J. Gastrointest. Surg. 2012;16(8). Search in Google Scholar

41. CHOI, Y., OH, D.-Y., KIM, T.-Y., LEE, K.-H., HAN, S.-W., IM, S.-A., et al. Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index. PLoS One 2015;10(10):e0139749. Search in Google Scholar

42. HA, Y., KIM, D., HAN, S., CHON, Y.E., LEE, Y. BIN, KIM, M.N., et al. Sarcopenia predicts prognosis in patients with newly diagnosed hepatocellular carcinoma, independent of tumor stage and liver function. Cancer Res. Treat. 2018;50(3). Search in Google Scholar

43. BEGINI, P., GIGANTE, E., ANTONELLI, G., CARBONETTI, F., IANNICELLI, E., ANANIA, G., et al. Sarcopenia predicts reduced survival in patients with hepatocellular carcinoma at first diagnosis. Ann. Hepatol. 2017;16(1). Search in Google Scholar

44. TAKAGI, K., YAGI, T., YOSHIDA, R., SHINOURA, S., UMEDA, Y., NOBUOKA, D., et al. Sarcopenia and American society of anesthesiologists physical status in the assessment of outcomes of hepatocellular carcinoma patients undergoing hepatectomy. Acta Med. Okayama 2016;70(5). Search in Google Scholar

45. ZHOU, G., BAO, H., ZENG, Q., HU, W., ZHANG, Q. Sarcopenia as a prognostic factor in Hepatolithiasis-associated intrahepatic cholangiocarcinoma patients following hepatectomy: A retrospective study. Int. J. Clin. Exp. Med. 2015;8(10). Search in Google Scholar

46. VAN VUGT, J.L.A., GASPERSZ, M.P., VUGTS, J., BUETTNER, S., LEVOLGER, S., DE BRUIN, R.W.F., et al. Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment. Dig. Surg. 2019;36(2). Search in Google Scholar

47. VAN VUGT, J.L.A., BUETTNER, S., LEVOLGER, S., COEBERGH VAN DEN BRAAK, R.R.J., SUKER, M., GASPERSZ, M.P., et al. Low skeletal muscle mass is associated with increased hospital expenditure in patients undergoing cancer surgery of the alimentary tract. PLoS One 2017;12(10). Search in Google Scholar

48. CHOI, M.H., YOON, S.B., LEE, K., SONG, M., LEE, I.S., LEE, M.A., et al. Preoperative sarcopenia and post-operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer. J. Cachexia. Sarcopenia Muscle 2018;9(2). Search in Google Scholar

49. SIMONSEN, C., DE HEER, P., BJERRE, E.D., SUETTA, C., HOJMAN, P., PEDERSEN, B.K., et al. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology. Ann. Surg. 2018;268(1):58–69. Search in Google Scholar

50. PANJE, C.M., HÖNG, L., HAYOZ, S., BARACOS, V.E., HERRMANN, E., GARCIA SCHÜLER, H., et al. Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy. Radiat. Oncol. 2019;14(1). Search in Google Scholar

51. YAMAMOTO, K., NAGATSUMA, Y., FUKUDA, Y., HIRAO, M., NISHIKAWA, K., MIYAMOTO, A., et al. Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer 2017;20(5). Search in Google Scholar

52. VAN VUGT, J.L.A., LEVOLGER, S., GHARBHARAN, A., KOEK, M., NIESSEN, W.J., BURGER, J.W.A., et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J. Cachexia. Sarcopenia Muscle 2017;8(2). Search in Google Scholar

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