Evaluation of body Computed Tomography-determined sarcopenia in breast cancer patients and clinical outcomes: A systematic review

Abstract Purpose Sarcopenia has been considered a poor prognostic factor in various malignant diseases. However, the studies that evaluated the association between CT-determined sarcopenia and outcome in breast cancer patients reported different results. Therefore, the aim of the present study is to perform a systematic review of the current literature on the evaluation of body CT-determined sarcopenia in breast cancer patients, focusing on the correlation with outcome values. Methods Two reviewers evaluated independently all studies dealing with CT-determined sarcopenia in breast cancer women from major medical libraries up to 24 April 2019. The keywords used for database searching were: “sarcopenia” or “muscles” or “muscle weight” or “body composition” and “breast neoplasms” or “breast cancer” and “computed tomography”. Studies reporting clinical outcome values were finally compared. Results Of the n  = 191 studies identified, a total of n  = 15 articles were included in the systematic review. In all studies, sarcopenia was assessed at the level of the third lumbar vertebra (L3) on CT; n  = 14/15 studies were retrospective. N  = 13/15 studies evaluated the impact of sarcopenia on clinical outcomes. Among these studies, n  = 8/13 studies concluded that sarcopenia is an important risk factor for poor prognosis in breast cancer and n  = 5/13 studies concluded that body composition changes are not associated with poor prognosis. Conclusions Most studies concluded that sarcopenia assessed on CT is an important prognostic risk factor in breast cancer patients. High-quality prospective studies to strongly confirm and assess the impact of sarcopenia evaluated on CT and breast cancer outcome are needed.