ABSTRACT INTRODUCTION Gynaecology cancers, including ovarian (OC), endometrial (EC), and cervical (CC), are prevalent with high mortality. Sarcopenia is found in 38.7% of cancer patients,

adversely affecting prognosis. Computed tomography (CT) is performed routinely in oncology, yet CT assessments of sarcopenia are not commonly used to measure prognosis. This systematic

review and meta-analysis aimed to evaluate the prognostic potential of pre-treatment sarcopenia assessments on overall survival (OS) and progression free survival (PFS) in gynaecology

cancer. METHODOLOGY Four electronic databases were systematically searched from 2000 to May 2020 in English: Ovid Medline, EMBASE, Web of Science, and CINAHL plus. Titles and abstracts were

results revealed a negative effect of pre-treatment sarcopenia on OS in OC (HR: 1.40, 1.20–1.64, _p_ < 0.0001) (_n_ = 10), EC (HR: 1.42, 0.97–2.10, _p_ = 0.07) (_n_ = 4) and CC (HR: 1.10,

0.93–1.31, _p_ = 0.28) (_n_ = 5), and a negative effect on PFS in OC (HR: 1.28, 1.11–1.46, _p_ = 0.0005) (_n_ = 8), EC (HR: 1.51, 1.03–2.20, _p_ = 0.03) (_n_ = 2) and CC (HR: 1.14,

0.85–1.53, _p_ = 0.37) (_n_ = 2). Longitudinal analysis indicated negative effects of muscle loss on survival. Overall, there was a high risk of bias. CONCLUSION Pre-treatment sarcopenia

negatively affected survival in gynaecology cancers. Incorporating such assessments into cancer management may be beneficial. Heterogeneity in sarcopenia assessments makes data

interpretation challenging. Further research in prospective studies is required. Access through your institution Buy or subscribe This is a preview of subscription content, access via your

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CHEMORADIOTHERAPY IN PATIENTS WITH STAGE III NON-SMALL-CELL LUNG CANCER: A RETROSPECTIVE ANALYSIS Article Open access 04 June 2021 PROGNOSTIC SIGNIFICANCE OF CT-DETERMINED SARCOPENIA IN

OLDER PATIENTS WITH ADVANCED SQUAMOUS CELL LUNG CANCER TREATED WITH PROGRAMMED DEATH-1 INHIBITORS Article Open access 26 May 2024 SIGNIFICANT MUSCLE LOSS AFTER STEREOTACTIC BODY RADIOTHERAPY

PREDICTS WORSE SURVIVAL IN PATIENTS WITH HEPATOCELLULAR CARCINOMA Article Open access 09 November 2022 REFERENCES * WCRF (World Cancer Research Fund). Diet, nutrition, physical activity and

cancer: a global perspective. Continuous Update Project Expert Report; 2018. * Menon U, Karpinskyj C, Gentry-Maharaj A. Ovarian cancer prevention and screening. Obstet Gynecol.

2018;131:909–27. https://doi.org/10.1097/AOG.0000000000002580. Article  PubMed  Google Scholar  * Ledford LRC, Lockwood S. Scope and epidemiology of gynecologic cancers: an overview. Semin

Oncol Nurs. 2019;35:147–50. https://doi.org/10.1016/j.soncn.2019.03.002. Article  PubMed  Google Scholar  * Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, et al.

Perioperative nutrition interventions for women with ovarian cancer. Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD009884.pub2. * Bray F, Ferlay J, Soerjomataram I,

Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin. 2018;68:394–424.

https://doi.org/10.3322/caac.21492. Article  Google Scholar  * Li H, Wu X, Cheng X. Advances in diagnosis and treatment of metastatic cervical cancer. J Gynecol Oncol. 2016;27:e43.

https://doi.org/10.3802/jgo.2016.27.e43. Article  CAS  PubMed  PubMed Central  Google Scholar  * Davidson B. Endometrial cancer: pathology and genetics. Encyclopedia of Cancer. 3rd ed.

Editor(s): Paolo Boffetta, Pierre Hainaut. Academic Press; 2018. p. 549–58. https://doi.org/10.1016/B978-0-12-801238-3.65262-5. * Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ,

Nautiyal J, et al. Risk factors for endometrial cancer: an umbrella review of the literature. Int J Cancer. 2019;145:1719–30. https://doi.org/10.1002/ijc.31961. Article  CAS  PubMed  Google

Scholar  * Bagaria M, Shields E, Bakkum-Gamez JN. Novel approaches to early detection of endometrial cancer. Curr Opin Obstet Gynecol. 2017;29:40–6.

https://doi.org/10.1097/GCO.0000000000000332. Article  PubMed  Google Scholar  * Passarello K, Kurian S, Villanueva V. Endometrial cancer: an overview of pathophysiology, management, and

care. Semin Oncol Nurs. 2019;35:157–65. https://doi.org/10.1016/j.soncn.2019.02.002. Article  PubMed  Google Scholar  * Elia M. The ‘MUST’ report: nutritional screening of adults: a

multidisciplinary responsibility. Reddich: BAPEN; 2003. * Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon k, et al. ESPEN guidelines on nutrition in cancer

patients. Clin Nutr. 2017;36:11–48. https://doi.org/10.1016/j.clnu.2016.07.015. Article  PubMed  Google Scholar  * Sadeghi M, Keshavarz-Fathi M, Baracos V, Arends J, Mahmoudi M, Rezaei N.

Cancer cachexia: diagnosis, assessment, and treatment. Crit Rev Oncol Hematol. 2018;127:91–104. https://doi.org/10.1016/j.critrevonc.2018.05.006. Article  PubMed  Google Scholar  * Sandri M.

Protein breakdown in cancer cachexia. Semin Cell Dev Biol. 2016;54:11–19. https://doi.org/10.1016/j.semcdb.2015.11.002. Article  CAS  PubMed  Google Scholar  * Rodrigues CS, Lacerda MS,

Chaves GV. Patient generated subjective global assessment as a prognosis tool in women with gynecologic cancer. Nutrition. 2015;31:1372–8. https://doi.org/10.1016/j.nut.2015.06.001. Article

  PubMed  Google Scholar  * Hertlein L, Kirschenhofer A, Fürst S, Beer D, Göß C, Lenhard M, et al. Malnutrition and clinical outcome in gynecologic patients. Eur J Obstet Gynecol Reprod

Biol. 2014;174:137–40. https://doi.org/10.1016/j.ejogrb.2013.12.028. Article  PubMed  Google Scholar  * Cantrell LA, Saks E, Grajales V, Duska L. Nutrition in gynecologic cancer. Curr Obstet

Gynecol Rep. 2015;4:265–71. https://doi.org/10.1007/s13669-015-0130-2. Article  Google Scholar  * Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among

gynaecological cancer patients. Eur J Clin Nutr. 2007;61:642–6. https://doi.org/10.1038/sj.ejcn.1602540. Article  CAS  PubMed  Google Scholar  * Obermair A, Simunovic M, Isenring L, Janda M.

Nutrition interventions in patients with gynecological cancers requiring surgery. Gynecol Oncol. 2017;145:192–9. https://doi.org/10.1016/j.ygyno.2017.01.028. Article  PubMed  Google Scholar

  * Ryan AM, Power DG, Daly L, Cushen SJ, Ní Bhuachalla E, Prado CM. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr

Soc. 2016;75:199–211. https://doi.org/10.1017/S002966511500419X. Article  PubMed  Google Scholar  * Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, et al. Prevalence of

malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017;8:79884–96. https://doi.org/10.18632/oncotarget.20168. Article  PubMed  PubMed Central  Google

Scholar  * Rauh S, Antonuzzo A, Bossi P, Eckert R, Fallon M, Fröbe A, et al. Nutrition in patients with cancer: a new area for medical oncologists? A practising oncologist’s

interdisciplinary position paper. ESMO Open. 2018;3:1–4. https://doi.org/10.1136/esmoopen-2018-000345. Article  Google Scholar  * Szewczuk M, Gasiorowska E, Matysiak K, Nowak-Markwitz E. The

role of artificial nutrition in gynecological cancer therapy. Ginekol Pol. 2019;90:167–72. https://doi.org/10.5603/GP.2019.0027. Article  PubMed  Google Scholar  * Baracos VE.

Cancer-associated malnutrition. Eur J Clin Nutr. 2018;72:1255–9. https://doi.org/10.1038/s41430-018-0245-4. Article  PubMed  Google Scholar  * Sun G, Li Y, Peng Y, Lu D, Zhang F, Cui X, et

al. Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis. Int J Colorectal Dis. 2018;33:1419–27.

https://doi.org/10.1007/s00384-018-3128-1. Article  PubMed  Google Scholar  * Vergara-Fernandez O, Trejo-Avila M, Salgado-Nesme N. Sarcopenia in patients with colorectal cancer: a

comprehensive review. World J Clin Cases. 2020;8:1188–202. https://doi.org/10.12998/wjcc.v8.i7.1188. Article  PubMed  PubMed Central  Google Scholar  * Cianci S, Rumolo V, Rosati A, Scaletta

G, Alletti SG, Cerentini TM, et al. Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Curr Pharm Des.

2019;25:2480–90. https://doi.org/10.2174/1381612825666190722112808. Article  CAS  PubMed  Google Scholar  * Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and

predictive value of pre-therapeutic sarcopenia in cancer patients: a systematic review. Clin Nutr. 2018;37:1101–13. https://doi.org/10.1016/j.clnu.2017.07.010. Article  PubMed  Google

Scholar  * Aust S, Knogler T, Pils D, Obermayr E, Reinthaller A, Zahn L, et al. Skeletal muscle depletion and markers for cancer cachexia are strong prognostic factors in epithelial ovarian

cancer. PLoS ONE. 2015;10:1–14. https://doi.org/10.1371/journal.pone.0140403. Article  CAS  Google Scholar  * Huang CY, Sun FJ, Lee J. Prognostic value of muscle measurement using the

standardized phase of computed tomography in patients with advanced ovarian cancer. Nutrition. 2020a;72:e110642. https://doi.org/10.1016/j.nut.2019.110642. Article  Google Scholar  * Ganju

RG, TenNapel M, Spoozak L, Chen AM, Hoover A. The impact of skeletal muscle abnormalities on tolerance to adjuvant chemotherapy and radiation and outcome in patients with endometrial cancer.

J Med Imaging Radiat Oncol. 2020;64:104–12. https://doi.org/10.1111/1754-9485.12935. Article  PubMed  Google Scholar  * Lee J, Chang CL, Lin J, Bin WMH, Sun FJ, Jan YT, et al. Skeletal

muscle loss is an imaging biomarker of outcome after definitive chemoradiotherapy for locally advanced cervical cancer. Clin Cancer Res. 2018;24:5028–36.

https://doi.org/10.1158/1078-0432.CCR-18-0788. Article  PubMed  Google Scholar  * Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European

consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. https://doi.org/10.1093/ageing/afy169. Article  PubMed  Google Scholar  * Ubachs J, Ziemons J, Minis-Rutten IJG, Kruitwagen

RFPM, Kleijnen J, Lambrechts S, et al. Sarcopenia and ovarian cancer survival: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019;10:1165–74.

https://doi.org/10.1002/jcsm.12468. Article  PubMed  PubMed Central  Google Scholar  * Nakayama N, Nakayama K, Nakamura K, Razia S, Kyo S. Sarcopenic factors may have no impact on outcomes

in ovarian cancer patients. Diagnostics. 2019;9:1–9. https://doi.org/10.3390/diagnostics9040206. Article  CAS  Google Scholar  * Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB,

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;9:629–35. https://doi.org/10.1016/S1470-2045(08)70153-0. Article  PubMed  Google Scholar  * Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in

adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer. 2016;57:58–67. https://doi.org/10.1016/j.ejca.2015.12.030. Article  PubMed  Google Scholar  * Riley RD, Moons

KG, Snell KE, Ensor J, Hooft L, Altman DG, et al. A guide to systematic review and meta-analysis of prognostic factor studies. BMJ. 2019;364:k4597. https://doi.org/10.1136/bmj.k4597. Article

  PubMed  Google Scholar  * Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.

Available from www.handbook.cochrane.org. * Hayden JA, van der Windt DA, Cartwright JL, Co P. Research and reporting methods annals of internal medicine assessing bias in studies of

prognostic factors. Ann Intern Med. 2013;158:280–6. https://doi.org/10.7326/0003-4819-158-4-201302190-00009. Article  PubMed  Google Scholar  * Begg C, Mazumdar M. Operating characteristics

of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101. Article  CAS  PubMed  Google Scholar  * Egger M, Smith G, Schneider M, Minder C. Bias in meta-analysis detected

by a simple, graphical test. BMJ. 1997;315:629–34. Article  CAS  PubMed  PubMed Central  Google Scholar  * Fragkos K, Tsagris M, Frangos C. Exploring the distribution for the estimator of

Rosenthal’s ‘fail-safe’ number of unpublished studies in meta-analysis. Commun Stat Theory Methods. 2016 (in press). * Sterne J, Sutton A, Ioannidis J, Terrin N, Jones D, Lau J, et al.

Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. Article  PubMed  Google Scholar  * Ataseven B,

Luengo TG, du Bois A, Waltering KU, Traut A, Heitz F, et al. Skeletal muscle attenuation (sarcopenia) predicts reduced overall survival in patients with advanced epithelial ovarian cancer

undergoing primary debulking surgery. Ann Surg Oncol. 2018;25:3372–9. https://doi.org/10.1245/s10434-018-6683-3. Article  PubMed  Google Scholar  * Bronger H, Hederich P, Hapfelmeier A, Metz

S, Noël PB, Kiechle M, et al. Sarcopenia in advanced serous ovarian cancer. Int J Gynecol Cancer. 2017;27:223–32. https://doi.org/10.1097/IGC.0000000000000867. Article  PubMed  Google

Scholar  * Conrad LB, Awdeh H, Acosta-Torres S, Conrad SA, Bailey AA, Miller DS, et al. Pre-operative core muscle index in combination with hypoalbuminemia is associated with poor prognosis

in advanced ovarian cancer. J Surg Oncol. 2018;117:1020–8. https://doi.org/10.1002/jso.24990. Article  PubMed  Google Scholar  * De Paula NS, Rodrigues CS, Chaves GV. Comparison of the

prognostic value of different skeletal muscle radiodensity parameters in endometrial cancer. Eur J Clin Nutr. 2019;73:524–30. https://doi.org/10.1038/s41430-018-0163-5. Article  PubMed 

Google Scholar  * Gillen J, Mills KA, Dvorak J, Xheng B, Thai T, Salani R, et al. Imaging biomarkers of adiposity and sarcopenia as potential predictors for overall survival among patients

with endometrial cancer treated with bevacizumab. Gynecologic Oncol Rep. 2019;30:100502. https://doi.org/10.1016/j.gore.2019.100502. Article  CAS  Google Scholar  * Huang CY, Yang YC, Chen

TC, Chen JR, Chen YJ, Wu MH, et al. Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced-stage ovarian cancer. J Cachexia Sarcopenia Muscle.

2020b;11:534–46. https://doi.org/10.1002/jcsm.12524. Article  PubMed  PubMed Central  Google Scholar  * Kim SI, Kim TM, Lee M, Kim HS, Chung HH, Cho JY, et al. Impact of ct-determined

sarcopenia and body composition on survival outcome in patients with advanced-stage high-grade serous ovarian carcinoma. Cancers. 2020;12:1–17. https://doi.org/10.3390/cancers12030559.

Article  CAS  Google Scholar  * Kiyotoki T, Nakamura K, Haraga J, Omichi C, Ida N, Saijo M, et al. Sarcopenia is an important prognostic factor in patients with cervical cancer undergoing

concurrent chemoradiotherapy. Int J Gynecol Cancer. 2018;28:168–75. https://doi.org/10.1097/IGC.0000000000001127. Article  PubMed  Google Scholar  * Kumar A, Moynagh MR, Multinu F, Cliby WA,

McGree ME, Weaver AL, et al. Muscle composition measured by CT scan is a measurable predictor of overall survival in advanced ovarian cancer. Gynecol Oncol. 2016;142:311–6.

https://doi.org/10.1016/j.ygyno.2016.05.027. Article  PubMed  Google Scholar  * Kuroki L, Mangano M, Allsworth J, Menias C, Massad L, Powell M, et al. Sarcopenia: pre-operative assessment of

muscle mass to predict surgical complications and prognosis in patients with endometrial cancer. Ann Surg Oncol. 2015;22:972–9. https://doi.org/10.1245/s10434-014-4040-8. Article  CAS 

PubMed  Google Scholar  * Lee J, Lin J, Bin WMH, Chang CL, Jan YT, Chen YJ. Muscle loss after chemoradiotherapy as a biomarker of distant failures in locally advanced cervical cancer.

Cancers. 2020;12:1–14. https://doi.org/10.3390/cancers12030595. Article  CAS  Google Scholar  * Lee J, Lin J, Bin WMH, Jan YT, Chang CL, Huang CY, et al. Muscle radiodensity loss during

cancer therapy is predictive for poor survival in advanced endometrial cancer. J Cachexia Sarcopenia Muscle. 2019;10:814–26. https://doi.org/10.1002/jcsm.12440. Article  PubMed  PubMed

Central  Google Scholar  * Matsubara Y, Nakamura K, Matsuoka H, Ogawa C, Masuyama H. Pre-treatment psoas major volume is a predictor of poor prognosis for patients with epithelial ovarian

cancer. Mol Clin Oncol. 2019;11:376–82. https://doi.org/10.3892/mco.2019.1912. Article  PubMed  PubMed Central  Google Scholar  * Matsuoka H, Nakamura K, Matsubara Y, Ida N, Nishida T, Ogawa

C, et al. Sarcopenia is not a prognostic factor of outcome in patients with cervical cancer undergoing concurrent chemoradiotherapy or radiotherapy. Anticancer Res. 2019;39:933–9.

https://doi.org/10.21873/anticanres.13196. Article  CAS  PubMed  Google Scholar  * Nattenmüller J, Rom J, Buckner T, Arvin J, Bau B, Sohn C, et al. Visceral abdominal fat measured by

computer tomography as a prognostic factor for gynecological malignancies? Oncotarget. 2018;9:16330–42. https://doi.org/10.18632/oncotarget.24667. Article  PubMed  PubMed Central  Google

Scholar  * Rodrigues CS, Chaves GV. Skeletal muscle quality beyond average muscle attenuation: a proposal of skeletal muscle phenotypes to predict short-term survival in patients with

endometrial cancer. JNCCN. 2018;16:153–60. https://doi.org/10.6004/jnccn.2017.7028. Article  PubMed  Google Scholar  * Rutten IJG, Ubachs J, Kruitwagen RFPM, van Dijk DPJ, Beets-Tan RGH,

Massuger LFAG, et al. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery. Eur J Surg Oncol. 2017a;43:717–24.

https://doi.org/10.1016/j.ejso.2016.12.016. Article  CAS  PubMed  Google Scholar  * Rutten IJG, Ubachs J, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, Van Gorp T. Psoas muscle area is

not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle. 2017b;8:630–8. https://doi.org/10.1002/jcsm.12180. Article 

PubMed  PubMed Central  Google Scholar  * Rutten IJG, van Dijk DPJ, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, van Gorp T. Loss of skeletal muscle during neoadjuvant chemotherapy is

related to decreased survival in ovarian cancer patients. J Cachexia Sarcopenia Muscle. 2016;7:458–66. https://doi.org/10.1002/jcsm.12107. Article  PubMed  PubMed Central  Google Scholar  *

Sanchez M, Castro-Eguiluz D, Luvián-Morales J, Jiménez-Lima R, Aguilar-Ponce JL, Isla-Ortiz D, et al. Deterioration of nutritional status of patients with locally advanced cervical cancer

during treatment with concomitant chemoradiotherapy. J Hum Nutr Diet. 2019;32:480–91. https://doi.org/10.1111/jhn.12649. Article  CAS  PubMed  Google Scholar  * Staley SA, Tucker K, Newton

M, Ertel M, Oldan J, Doherty I, et al. Sarcopenia as a predictor of survival and chemotoxicity in patients with epithelial ovarian cancer receiving platinum and taxane-based chemotherapy.

Gynecol Oncol. 2020;156:695–700. https://doi.org/10.1016/j.ygyno.2020.01.003. Article  CAS  PubMed  Google Scholar  * Yoshikawa N, Shirakawa A, Yoshida K, Tamauchi S, Suzuki S, Kikkawa F, et

al. Sarcopenia as a predictor of survival among patients with organ metastatic cervical cancer. Nutr Clin Pr. 2020;00:1–6. https://doi.org/10.1002/ncp.10482. Article  CAS  Google Scholar  *

Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin M, McCargar L, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of

body mass index. J Clin Oncol. 2013;31:1539–47. Article  PubMed  Google Scholar  * Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach

to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33:997–1006.

https://doi.org/10.1139/H08-075. Article  PubMed  Google Scholar  * Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer

cachexia: an international consensus. Lancet Oncol. 2011;12:489–95. https://doi.org/10.1016/S1470-2045(10)70218-7. Article  PubMed  Google Scholar  * Rinninella E, Fagotti A, Cintoni M,

Raoul P, Scaletta G, Scambia G, et al. Skeletal muscle mass as a prognostic indicator of outcomes in ovarian cancer: a systematic review and meta-analysis. Int J Gynecol Cancer.

2020;30:654–63. https://doi.org/10.1136/ijgc-2020-001215. Article  PubMed  Google Scholar  * McSharry V, Mullee A, McCann L, Rogers AC, McKiernan M, Brennan DJ. The impact of sarcopenia and

low muscle attenuation on overall survival in epithelial ovarian cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2020;10:1165–74. https://doi.org/10.1245/s10434-020-08382-0.

Article  Google Scholar  * Allanson ER, Peng Y, Choi A, Hayes S, Janda M, Obermair A. A systematic review and meta-analysis of sarcopenia as a prognostic factor in gynecological malignancy.

Int J Gynecol Cancer. 2020. https://doi.org/10.1136/ijgc-2020-001678. * Aleixo GFP, Shachar SS, Nyrop KA, Muss HB, Malpica L, Williams GR. Myosteatosis and prognosis in cancer: systematic

review and meta-analysis. Crit Rev Oncol Hematol. 2020;145:102839. https://doi.org/10.1016/j.critrevonc.2019.102839. Article  CAS  PubMed  Google Scholar  * Weinberg MS, Shachar SS, Muss HB,

Deal AM, Popuri K, Yu H, et al. Beyond sarcopenia: characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population. Breast J.

2018;24:278–84. https://doi.org/10.1111/tbj.12952. Article  PubMed  Google Scholar  * Jones KI, Doleman B, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a

quick and easy method to assess sarcopenia and predicts major surgical complications. Color Dis. 2015;17:20–26. https://doi.org/10.1111/codi.12805. Article  Google Scholar  * Sebro R,

O’Brien L, Torriani M, Bredella MA. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine. Skelet Radio.

2016;45:1221–6. https://doi.org/10.1007/s00256-016-2405-8. Article  Google Scholar  * Daly LE, Ní Bhuachalla ÉB, Power DG, Cushen SJ, James K, Ryan AM. Loss of skeletal muscle during

systemic chemotherapy is prognostic of poor survival in patients with foregut cancer. J Cachexia Sarcopenia Muscle. 2018;9:315–25. https://doi.org/10.1002/jcsm.12267. Article  PubMed  PubMed

Central  Google Scholar  * Bozzetti F. Chemotherapy-induced sarcopenia. Curr Treat Options Oncol. 2020;21. https://doi.org/10.1007/s11864-019-0691-9. * Hojan K, Milecki P, Molinska-Glura M,

Roszak A, Leszczynski P. Effect of physical activtiy on bone strength and body composition in breast cancer premenopausal women during endocrine therapy. Eur J Phys Rehab Med.

2013;49:331–9. CAS  Google Scholar  * Tan BHL, Birdsell LA, Martin L, Baracos VE, Fearon KCH. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic

cancer. Clin Cancer Res. 2009;15:6973–9. https://doi.org/10.1158/1078-0432.CCR-09-1525. Article  CAS  PubMed  Google Scholar  * Trivella M. Systematic reviews of prognostic factor studies

(section: estimating the hazard ratio) [DPhil]. University of Oxford; 2006. Download references ACKNOWLEDGEMENTS ES would like to acknowledge her affiliation with the Division of Medicine,

University College London, and Dr Marialena Trivella who provided invaluable support with the statistical analysis. No financial assistance was received. AUTHOR INFORMATION AUTHORS AND

AFFILIATIONS * University College London, London, UK E. H. Sutton, M. Plyta, K. Fragkos & S. Di Caro Authors * E. H. Sutton View author publications You can also search for this author

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author inPubMed Google Scholar * S. Di Caro View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS ES led the review, was responsible for

designing the review protocol, writing the protocol and report, conducting the search, screening eligible studies, extracting and analysing data, conducting meta-analysis, deriving all

tables and figures. MP supported the research process, made critical comments that helped in the interpretation of results, supported in writing sections of the report, and reviewed the

final report. SDC provided expert clinical advice and reviewed the final report. KF reviewed the final report. CORRESPONDING AUTHOR Correspondence to E. H. Sutton. ETHICS DECLARATIONS

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Fragkos, K. _et al._ Pre-treatment sarcopenic assessments as a prognostic factor for gynaecology cancer outcomes: systematic review and meta-analysis. _Eur J Clin Nutr_ 76, 1513–1527

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