Neoadjuvant therapy-related skeletal muscle reduction and postoperative outcomes after gastrectomy for gastric cancer: a systematic review and meta-analysis.
- 1Department of Gastrointestinal Surgery, Affiliated Heping Hospital of Changzhi Medical College, Changzhi, China.
- 2Department of Hepatobiliary Surgery, Zhangjiakou First Hospital, Zhangjiakou, China.
- 3Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract
Skeletal muscle (SM) reduction during neoadjuvant therapy (NAT) is increasingly recognized in patients with gastric cancer (GC), but its association with postoperative outcomes remains unclear. This study aimed to evaluate the association between NAT-related SM reduction and postoperative mortality, recurrence, and complications after gastrectomy for GC. This systematic review and meta-analysis was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420261292160. MEDLINE/PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception through December 15, 2025, for observational studies evaluating NAT-related muscle reduction and postoperative outcomes in GC. Muscle reduction was primarily defined by changes in the SM index (SMI) between pre- and post-NAT assessments. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models. Eleven studies were included in the systematic review, and eight contributed to the meta-analysis. NAT-related muscle reduction was associated with higher postoperative mortality at 1 year (OR 2.51, 95% CI: 1.03-6.13, P=0.04), 3 years (OR 2.67, 95% CI: 1.36-5.26, P<0.01), and 5 years (OR 1.86, 95% CI: 1.18-2.93, P=0.01). It was also associated with higher recurrence at 1 year (OR 2.00, 95% CI: 1.01-3.97, P=0.05), 3 years (OR 1.48, 95% CI: 1.03-2.12, P=0.03), and 5 years (OR 1.53, 95% CI: 1.08-2.17, P=0.02). The association with 1-year mortality was not robust in leave-one-out sensitivity analyses, whereas the 3- and 5-year mortality estimates remained stable. No clear association was observed between NAT-related muscle reduction and overall postoperative complications (OR 1.04, 95% CI: 0.66-1.63, P=0.86). NAT-related SM reduction was associated with increased long-term mortality and recurrence after gastrectomy for GC, but not with short-term postoperative complications. Routine assessment of dynamic body composition changes during NAT may help identify high-risk patients and guide targeted nutritional support and prehabilitation.
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BibTeX
@article{li2026neoadjuvant,
title = {{Neoadjuvant therapy-related skeletal muscle reduction and postoperative outcomes after gastrectomy for gastric cancer: a systematic review and meta-analysis.}},
author = {Lulu Li and Jingyu Zhang and Haikuo Wang and Chenyu Gou and Xiaohu Wang and Yuan He and Yantao Tian},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = aug,
doi = {10.21037/jgo-2026-0722},
url = {https://europepmc.org/article/MED/42996835},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Neoadjuvant therapy-related skeletal muscle reduction and postoperative outcomes after gastrectomy for gastric cancer: a systematic review and meta-analysis.
AU - Lulu Li
AU - Jingyu Zhang
AU - Haikuo Wang
AU - Chenyu Gou
AU - Xiaohu Wang
AU - Yuan He
AU - Yantao Tian
PY - 2026
DA - 2026/08/10
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0722
UR - https://europepmc.org/article/MED/42996835
AB - Skeletal muscle (SM) reduction during neoadjuvant therapy (NAT) is increasingly recognized in patients with gastric cancer (GC), but its association with postoperative outcomes remains unclear. This study aimed to evaluate the association between NAT-related SM reduction and postoperative mortality, recurrence, and complications after gastrectomy for GC. This systematic review and meta-analysis was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420261292160. MEDLINE/PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception through December 15, 2025, for observational studies evaluating NAT-related muscle reduction and postoperative outcomes in GC. Muscle reduction was primarily defined by changes in the SM index (SMI) between pre- and post-NAT assessments. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models. Eleven studies were included in the systematic review, and eight contributed to the meta-analysis. NAT-related muscle reduction was associated with higher postoperative mortality at 1 year (OR 2.51, 95% CI: 1.03-6.13, P=0.04), 3 years (OR 2.67, 95% CI: 1.36-5.26, P<0.01), and 5 years (OR 1.86, 95% CI: 1.18-2.93, P=0.01). It was also associated with higher recurrence at 1 year (OR 2.00, 95% CI: 1.01-3.97, P=0.05), 3 years (OR 1.48, 95% CI: 1.03-2.12, P=0.03), and 5 years (OR 1.53, 95% CI: 1.08-2.17, P=0.02). The association with 1-year mortality was not robust in leave-one-out sensitivity analyses, whereas the 3- and 5-year mortality estimates remained stable. No clear association was observed between NAT-related muscle reduction and overall postoperative complications (OR 1.04, 95% CI: 0.66-1.63, P=0.86). NAT-related SM reduction was associated with increased long-term mortality and recurrence after gastrectomy for GC, but not with short-term postoperative complications. Routine assessment of dynamic body composition changes during NAT may help identify high-risk patients and guide targeted nutritional support and prehabilitation.
SN - 2078-6891
SN - 2219-679X
ER -