Sarcopenia defined by serum creatinine and cystatin C predicts poor survival outcomes in patients with cancers

BACKGROUND: The prognostic significance of sarcopenia estimated by serum creatinine and cystatin C in cancer patients remained inconsistent. The purpose of the meta-analysis was to comprehensively evaluate the association between creatinine/cystatin C ratio(CCR) or sarcopenia index(SI) and survival outcomes in cancer patients with sarcopenia. METHODS: A comprehensive search of relevant studies was implemented by scrutinizing Pubmed, Web of science and Embase databases until June 30, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to evaluate the survival outcomes. RESULTS: 18 studies from 17 articles involving 9908 patients were enrolled in the study. The meta-analysis indicated that low CCR was significantly associated with poor overall survival (OS) (HR:1.71,95% CI: 1.42-2.06), progression free survival (PFS)((HR: 1.76; 95% CI: 1.33-2.34), recurrence free survival (RFS)(HR: 2.48; 95% CI: 1.52-4.05). Low SI was correlated with poor OS (HR: 1.60; 95% CI: 1.21-2.13). Subgroup analysis demonstrated that low CCR was an adverse prognostic marker not affected by cancer type, treatment method, country and analysis type. CONCLUSIONS: Sarcopenia assessed by CCR or SI predicted unfavorable prognosis in cancer patients. CCR or SI can be used as an effective and convenient indicator of sarcopenia in cancer patients.