Prognostic value of sarcopenia in survivors of hematological malignances undergoing a hematopoietic stem cell transplantation: a systematic review and meta-analysis.

肌少症在接受造血干细胞移植的恶性血液病幸存者中的预后价值: 系统综述和荟萃分析。

  • 影响因子:2.83
  • DOI:10.1007/s00520-020-05359-3
  • 作者列表:"Jia S","Qiao R","Xiao Y","Qin D","Zhao W","Zhao Y","Liu X","Dong B
  • 发表时间:2020-08-01

PURPOSE:Sarcopenia is increasingly recognized as an independent risk factor for poor outcomes in patients undergoing hematopoietic stem cell transplantation (HSCT), and it is a potentially modifiable factor. The purpose of the present systematic review and meta-analysis is to summarize and integrate current evidence in this field. METHODS:We searched EMBASE, MEDLINE, and Cochrane DSR through Ovid and PubMed websites to identify relevant studies. Studies evaluated sarcopenia before HSCT and reported associations between sarcopenia and post-transplant outcomes were included. Two authors independently applied eligibility criteria, assessed quality, and extracted data. Odds ratio (OR) and their 95% confidence intervals (CIs) were pooled to examine the association between sarcopenia and post-transplant outcomes by using the review manager 5.3 software. RESULTS:Seven retrospective cohort studies met our inclusion criteria. The overall quality of studies was low to moderate. Sarcopenia was associated with higher non-relapse mortality [odds ratio (OR) 1.97; 95% CI 1.45, 2.68; P < 0.0001; I2 = 0%] and shorter overall survival [odds ratio (OR) 0.44; 95% CI 0.26, 0.75; P = 0.002; I2 = 65%] in patients undergoing HSCT. CONCLUSIONS:Clinicians could use sarcopenia to balance the risks and benefits of transplantation as early as possible; in addition, interventions can be used to prevent sarcopenia and improve physical function and quality of life. Well-designed, prospective, and large-scale clinical studies are needed to consolidate the evidence.


目的: 肌少症越来越被认为是造血干细胞移植 (HSCT) 患者预后不良的独立危险因素,并且是一个潜在的可改变因素。本系统综述和荟萃分析的目的是总结和整合该领域的现有证据。 方法: 我们通过Ovid和PubMed网站检索EMBASE、MEDLINE和Cochrane DSR,以确定相关研究。研究评估了HSCT前的肌少症,并报告了肌少症与移植后结果之间的相关性。两位作者独立应用资格标准,评估质量,并提取数据。通过使用review manager 95% 软件,将优势比 (OR) 及其5.3置信区间 (CIs) 合并,以检查肌少症与移植后结局之间的相关性。 结果: 7项回顾性队列研究符合我们的纳入标准。研究的总体质量为低到中等。骨骼肌减少与较高的非复发死亡 [比值比 (OR) 为1.97; 95% CI 1.45,2.68; P <  0.0001; I2   =   0%] 短生存期 [比值比 (OR) 为0.44; 95% CI 0.26,0.75; P  =   0.002; 在接受HSCT的患者中,I2   =   65%]。 结论: 临床医生可以尽早利用肌少症来平衡移植的风险和益处; 此外,干预措施可用于预防肌少症,改善身体功能和生活质量。需要设计良好、前瞻性、大规模的临床研究来巩固证据。



作者列表:["Liu D","Yan J","Qiao J"]

METHODS::A decrease in cancer deaths has resulted in the possibility of child bearing for many young adult cancer survivors. Most antitumor treatment modalities are detrimental to female fertility, and methods for fertility preservation before gonadotoxic treatment, including cryopreservation of oocytes, embryos and ovarian tissue, have therefore been developed. This review focuses on the ovarian function of cancer patients, the safety and efficacy of fertility preservation methods, and the pregnancy outcomes of these patients. Breast cancer and hematological tumors constitute the majority of cancers in reproductive-aged female oncology patients. Ovarian function may not be impacted by breast cancer cells, while in patients with hematological malignancies, decreases in anti-Müllerian hormone and antral follicle counts have been demonstrated. In most cases, patients can undergo ovarian stimulation without delaying treatment, and a new stimulation protocol known as dual stimulation, which may be more efficient, has now been developed. Birth outcomes are also acceptable in cancer patients.

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作者列表:["Li R","Shinde A","Novak J","Vapiwala N","Beriwal S","Amini A","Chen YJ","Glaser S"]

METHODS:PURPOSE:We sought to characterize temporal trends of radiation oncology resident-reported external beam radiation therapy (EBRT) case experience with respect to various disease sites, including trends in stereotactic radiosurgery and stereotactic body radiation therapy cases. METHODS AND MATERIALS:Summarized, deidentified case logs for graduating radiation oncology residents between 2007 and 2018 were obtained from the Accreditation Council for Graduate Medical Education national summary data report. Mean number of cumulative cases and standard deviations per graduating resident by year were evaluated. Cases were subdivided into 12 disease-site categories using the Accreditation Council for Graduate Medical Education classification. Analysis of variance was used to determine significant differences, and strength of association was evaluated using Pearson correlation. RESULTS:The number of graduating residents per year increased by 66% from 114 in 2007 to 189 in 2018 (P < .001, r = 0.88). The overall mean number of EBRT cases per graduating resident decreased by 13.2% from 521.9 in 2007 to 478.5 in 2018, with a decrease in the ratio of nonmetastatic to metastatic cases per graduating resident. There was significant variation among the disease categories analyzed; however, the largest proportionate decreases were seen in hematologic, lung, and genitourinary malignancies. Stereotactic radiosurgery volume per graduating resident increased from an average of 27.9 cases in 2007 to 50.3 in 2018 (P < .001, r = 0.96). Stereotactic body radiation therapy volume per graduating resident increased as well, from a mean of 6 cases in 2007 to 55.6 cases in 2018 (P < .001, r = 0.99). CONCLUSIONS:We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.

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作者列表:["Fukushima T","Nakano J","Ishii S","Natsuzako A","Sato S","Sakamoto J","Miyazaki Y","Okita M"]

METHODS:PURPOSE:Muscle dysfunction such as loss of muscle mass and decreased muscle strength is often observed in patients with hematologic malignancies. However, specific factors associated with muscle function have not been identified. The purpose of this study was to identify significant factors affecting muscle function in patients with hematologic malignancies. METHODS:This was a cross-sectional, observational study. Eighty-eight inpatients with hematologic malignancies undergoing chemotherapy were recruited. Participants were evaluated for muscle thickness and isometric knee extensor strength as indicators of muscle function, physical activity, physical symptoms, psychological distress, and self-efficacy at the start date of rehabilitation. Multiple regression analysis with muscle function as the dependent variable and clinical information and other evaluation items as explanatory variables was performed. RESULTS:Lymphocyte count, the geriatric nutritional risk index, and physical activity were significant factors associated with muscle thickness, while physical activity and self-efficacy were significant factors associated with isometric knee extensor strength. CONCLUSIONS:Nutritional status, physical activity, and self-efficacy were significant factors associated with muscle function in patients with hematologic malignancies. Rehabilitation intervention focusing on improving physical activity and nutritional status should be considered necessary for enhancing muscle function in patients with hematologic malignancies.

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