# Predictive value of osteopenia as prognostic marker for survival and recurrence in patients with gastrointestinal cancers: a systematic review and meta-analysis

## TL;DR

This study finds that low bone density and muscle loss are strong predictors of poor outcomes in gastrointestinal cancer patients.

## Contribution

The study provides a meta-analysis confirming osteopenia and osteosarcopenia as reliable prognostic markers for survival and recurrence in GI cancers.

## Key findings

- Osteopenia significantly increases the risk of mortality and recurrence in GI cancer patients.
- Osteosarcopenia is associated with threefold higher mortality and increased recurrence risk.
- The associations are consistent across different subgroups and contexts.

## Abstract

Early detection, systematic prevention, and personalized therapy are crucial to reduce mortality in patients with gastrointestinal (GI) cancers. This systematic review and meta-analysis aimed to clarify the predictive value of osteopenia and osteosarcopenia as prognostic markers of survival and recurrence in patients with GI cancers.

Medline, Google Scholar, and Science Direct databases were searched for English-language studies that included patients who underwent surgical resection following a pathologically diagnosed GI cancer and reported the association between osteopenia and osteosarcopenia on the overall survival (OS) and recurrence-free survival (RFS). Meta-analysis was done using STATA 14.2, and the results were reported as pooled hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic and the Chi-square test. Study quality was evaluated using the Newcastle Ottawa Scale (NOS).

A comprehensive literature search yielded 23 eligible studies, primarily from Japan. Osteopenia emerged as a significant risk factor for both OS (pooled HR 2.20, 95% CI: 1.74–2.79) and RFS (pooled HR 2.15, 95% CI: 1.60–2.89). Patients with osteosarcopenia exhibited threefold higher mortality rates (pooled HR 2.96, 95% CI: 1.99–4.40) and heightened risk of recurrence (pooled HR 2.75, 95% CI: 1.79–4.24). Subgroup analyses underscored the consistency of these associations across diverse contexts.

This meta-analysis establishes osteopenia and osteosarcopenia as robust prognostic indicators for survival and recurrence in GI cancers. Integrating musculoskeletal assessments into routine oncological care is imperative for timely interventions and optimized patient outcomes.