SP10.9 Impact of sarcopenia on prognosis following neoadjuvant chemotherapy and resection for locally advanced rectal cancer

Abstract Aims Sarcopenia is characterised by the progressive and generalised loss of muscle mass and function. There is an increasing body of evidence to suggest that cancer patients with pre-existing sarcopenia are at a greater risk of both short- and long-term clinical complications. The aim of this review is to examine the impact of pre-existing sarcopenia on prognostic outcomes in patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) prior to surgery. Methods Medline, PubMed and Embase databases were searched from inception to October 2021. Any comparative studies relating to the prognostic outcomes of sarcopenic versus non-sarcopenic patients with LARC who received nCRT prior to surgery were included. Risk of bias was assessed using ROBINS-I. Meta-analysis was performed on reported hazard ratios (HR) and 95% confidence intervals (CI) using DerSimonian–Laird random-effects models. Results A total of 598 patients from 5 studies were included in the analysis of hazard ratios for overall survival, whilst 505 patients from 4 studies were available for analysis of HR for disease-free survival. Meta regression analysis showed a significant association between pre-existing sarcopenia and worse overall survival (HR: 1.69, 95% CI: 1.15-2.48). The association between pre-existing sarcopenia and shorter disease-free survival was not statistically significant (HR: 1.07, 95% CI: 0.63-1.82). Conclusions The review highlights the role body composition can play on prognostic outcomes in patients undergoing multi-modal cancer treatment. Given the complex underpinnings of sarcopenia progression, more research is needed to develop strategies to mitigate this impact in a physiologically vulnerable population.