Sarcopenia e toxicidade quimioterápica em pacientes oncológicos: revisão sistemática e metanálise

Abstract

Cancer represents a public health problem being, worldwide, among the four main causes of premature death in most countries. Treatment can be done through surgery, radiotherapy, chemotherapy or bone marrow transplantation, which may require a combination of more than one modality. One of the main factors that reduces tolerance to chemotherapy includes a sarcopenia, which predicts an increased risk of chemotherapy toxicity, impacting on the interruption and tolerance of antineoplastic therapy with a worsening in the prognosis of patients with cancer. This study aims to quantitatively evaluate, through a systematic review, the association of sarcopenia with chemotherapy toxicity in cancer patients. The databases that made up the search included: Embase, MEDLINE (via PubMed), Cochrane Library, Lilacs, Web of Science and Scopus. The study report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) compliance. Gray literature was considered in the process of searching for evidence, manually, including conference proceedings of the last 5 years and contact with specialists and researchers in the area as an additional source of information. A pair of researchers carried out the selection of studies independently, in stages, with analysis of titles and titles and abstracts, respectively, and, a posteriori, analysis of the full text. The resolution of disagreements fell to a third reviewer. Methodological quality was assessed by The Cochrane Collaboration's risk of bias and the quality of evidence by the Grading of Recommendations Assessment Development and Evaluation (GRADE). The meta-analytic analysis comprised eight articles and the systematic review nine clinical trials. From the inclusion of studies as subgroups that reported specific toxicities aThe chance of developing toxicity in the sarcopenic public is 49% higher compared to the non-sarcopenic group (OR = 1.49 95% CI: 1.14 - 1.93). The interpretation in the meta-analytic analysis regarding the general heterogeneity presents I² = 0%, (acceptable/mild), with a value of p=0.55, not significant and T² = 0. The analysis demonstrates that sarcopenic patients exhibit greater toxicity, , independently of the meta-analytic analysis presented in this work, although variable association measures, all converged favorably to greater toxicity in sarcopenics, whether considering the most prevalent toxicities, including individual toxic events as reported in the studies or exposing the toxicity in individuals with and without sarcopenia.