Sarcopenia on immune checkpoint inhibitors in solid tumor patients with sarcopenia: A meta-analysis

doi:10.3969/j.issn.1004-583X.2022.10.002

Abstract

Abstract:

Objective To explore the effect of sarcopenia on the short-term efficacy, long-term prognosis and immune-related adverse events (irAEs) of immune checkpoint Inhibitor (ICIs). Methods A systematic search were conducted in the PubMed, EMBASE, and Cochrane databases to include relevant studies published before June 2021. Results A total of 27 studies were included in the Meta-analysis, which showed that the patients with sarcopenia had worse the objective response rate (RR=0.11, 95%CI: 0.02-0.54) and disease control rate (RR=0.55, 95%CI:0.39-0.78) than those without the disease. In addition, pooled sarcopenia was found to be a unfavorable prognostic factor of prognosis in tumor patients (OS: HR=1.60, 95%CI: 1.30-1.97; PFS: HR=2.81, 95%CI: 1.88-4.22). Furthermore, sarcopenia tended toward irAEs (RR=1.27;95%CI:0.74-2.19). Conclusion Sarcopenia may be considered as a risk factor for poor therapeutic effect and prognosis in cancer patients.

Key words: sarcopenia, immune checkpoint inhibitors, cancer immunotherapy, prognosis

CLC Number:

R746.4

Ye Qian, Ling Zhi, Yin Xudong. Sarcopenia on immune checkpoint inhibitors in solid tumor patients with sarcopenia: A meta-analysis[J]. Clinical Focus, 2022, 37(10): 889-898.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.10.002

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I10/889

Figures/Tables 11

References 43

[1]	Floudas CS, Brar G, Greten TF. Immunotherapy: Current status and future perspectives[J]. Dig Dis Sci, 2019, 64(4):1030-1040. doi: 10.1007/s10620-019-05516-7 URL
[2]	Schoenfeld AJ, Hellmann MD. Acquired resistance to immune checkpoint inhibitors[J]. Cancer Cell, 2020, 37(4):443-455. doi: S1535-6108(20)30157-4 pmid: 32289269
[3]	Bai R, Lv Z, Xu D, et al. Predictive biomarkers for cancer immunotherapy with immune checkpoint inhibitors[J]. Biomark Res, 2020, 8:34. doi: 10.1186/s40364-020-00209-0 pmid: 32864131
[4]	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(4):601. doi: 10.1093/ageing/afz046 pmid: 31081853
[5]	Morosano ME, Menoyo IM, Tomat MF, et al. A simple anthropometric tool for the assessment of pre-sarcopenia in postmenopausal women[J]. Climacteric, 2017, 20(3):256-261. doi: 10.1080/13697137.2017.1309017 pmid: 28379719
[6]	Ofek Shlomai N, Rao S, Patole S. Efficacy of interventions to improve hand hygiene compliance in neonatal units: A systematic review and meta-analysis[J]. Eur J Clin Microbiol Infect Dis, 2015, 34(5):887-897. doi: 10.1007/s10096-015-2313-1 URL
[7]	Dercle L, Ammari S, Champiat S, et al. Rapid and objective CT scan prognostic scoring identifies Metastatic patients with long-term clinical benefit on anti-PD-1/-L1 therapy[J]. Eur J Cancer, 2016, 65:33-42. doi: 10.1016/j.ejca.2016.05.031 URL
[8]	Shiroyama T, Nagatomo I, Koyama S, et al. Impact of sarcopenia in patients with advanced non-small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study[J]. Sci Rep, 2019, 9(1):2447. doi: 10.1038/s41598-019-39120-6 pmid: 30792455
[9]	Nishioka N, Uchino J, Hirai S, et al. Association of sarcopenia with and efficacy of anti-PD-1/PD-L1 therapy in non-small-cell lung cancer[J]. J Clin Med, 2019, 8(4):450. doi: 10.3390/jcm8040450 URL
[10]	Cortellini A, Bozzetti F, Palumbo P, et al. Weighing the role of skeletal muscle mass and muscle density in cancer patients receiving PD-1/PD-L1 checkpoint inhibitors: A multicenter real-life study[J]. Sci Rep, 2020, 10(1):1456. doi: 10.1038/s41598-020-58498-2 pmid: 31996766
[11]	Crombé A, Kind M, Toulmonde M, et al. Impact of CT-based body composition parameters at baseline, their early changes and response in metastatic cancer patients treated with immune checkpoint inhibitors[J]. Eur J Radiol, 2020, 133:109340. doi: 10.1016/j.ejrad.2020.109340 URL
[12]	Roch B, Coffy A, Jean-Baptiste S, et al. Cachexia-sarcopenia as a determinant of disease control rate and survival in non-small lung cancer patients receiving immune-checkpoint inhibitors[J]. Lung Cancer, 2020, 143:19-26. doi: 10.1016/j.lungcan.2020.03.003 URL
[13]	Takada K, Yoneshima Y, Tanaka K, et al. Clinical impact of skeletal muscle area in patients with non-small cell lung cancer treated with anti-PD-1 inhibitors[J]. J Cancer Res Clin Oncol, 2020, 146(5):1217-1225. doi: 10.1007/s00432-020-03146-5 pmid: 32025867
[14]	Bilen MA, Martini DJ, Liu Y, et al. Combined effect of sarcopenia and systemic inflammation on survival in patients with advanced stage cancer treated with immunotherapy[J]. Oncologist, 2020, 25(3):e528-e535. doi: 10.1634/theoncologist.2019-0751 URL
[15]	Kim N, Yu JI, Park HC, et al. Incorporating sarcopenia and inflammation with radiation therapy in patients with hepatocellular carcinoma treated with nivolumab[J]. Cancer Immunol Immunother, 2021, 70(6):1593-1603. doi: 10.1007/s00262-020-02794-3 pmid: 33231725
[16]	Kano M, Hihara J, Tokumoto N, et al. Association between skeletal muscle loss and the response to nivolumab immunotherapy in advanced gastric cancer patients[J]. Int J Clin Oncol 2021, 26(3):523-531. doi: 10.1007/s10147-020-01833-4 pmid: 33226523
[17]	Shimizu T, Miyake M, Hori S, et al. Clinical impact of sarcopenia and inflammatory/nutritional markers in patients with unresectable Metastatic urothelial carcinoma treated with pembrolizumab[J]. Diagnostics (Basel), 2020, 10(5).
[18]	Fukushima H, Fukuda S, Moriyama S, et al. Impact of sarcopenia on the efficacy of pembrolizumab in patients with advanced urothelial carcinoma: A preliminary report[J]. Anticancer Drugs, 2020, 31(8):866-871. doi: 10.1097/CAD.0000000000000982 pmid: 32740015
[19]	Cortellini A, Verna L, Porzio G, et al. Predictive value of skeletal muscle mass for immunotherapy with nivolumab in non-small cell lung cancer patients: A "hypothesis-generator" preliminary report[J]. Thorac Cancer, 2019, 10(2):347-351. doi: 10.1111/1759-7714.12965 pmid: 30600905
[20]	Nishioka N, Naito T, Notsu A, et al. Unfavorable impact of decreased muscle quality on the efficacy of immunotherapy for advanced non-small cell lung cancer[J]. Cancer Med, 2021, 10(1):247-256. doi: 10.1002/cam4.3631 URL
[21]	Daly LE, Power DG, O'Reilly A, et al. The impact of body composition parameters on ipilimumab toxicity and survival in patients with Metastatic melanoma[J]. Br J Cancer 2017, 116(3):310-317. doi: 10.1038/bjc.2016.431 URL
[22]	Deike-Hofmann K, Gutzweiler L, Reuter J, et al. Macroangiopathy is a positive predictive factor for response to immunotherapy[J]. Sci Rep, 2019, 9(1):9728. doi: 10.1038/s41598-019-46189-6 pmid: 31278360
[23]	Chu MP, Li Y, Ghosh S, Sass S, et al. Body composition is prognostic and predictive of ipilimumab activity in Metastatic melanoma[J]. J Cachexia Sarcopenia Muscle, 2020, 11(3):748-755. doi: 10.1002/jcsm.12538 pmid: 32053287
[24]	Hirsch L, Bellesoeur A, Boudou-Rouquette P, et al. The impact of body composition parameters on severe toxicity of nivolumab[J]. Eur J Cancer, 2020, 124:170-177. doi: S0959-8049(19)30810-X pmid: 31794927
[25]	Hu JB, Ravichandran S, Rushing C, et al. Higher BMI, but not sarcopenia, is associated with pembrolizumab-related toxicity in patients with advanced melanoma[J]. Anticancer Res, 2020, 40(9):5245-5254. doi: 10.21873/anticanres.14528 pmid: 32878813
[26]	Young AC, Quach HT, Song H, et al. Impact of body composition on outcomes from anti-PD1 +/- anti-CTLA-4 treatment in melanoma[J]. J Immunother Cancer, 2020, 8(2).
[27]	Akce M, Liu Y, Zakka K, Martini DJ, et al. Impact of sarcopenia, BMI, and inflammatory biomarkers on survival in advanced hepatocellular carcinoma treated with anti-PD-1 antibody[J]. Am J Clin Oncol, 2021, 44(2):74-81. doi: 10.1097/COC.0000000000000787 URL
[28]	Minami S, Ihara S, Tanaka T, et al. Sarcopenia and visceral adiposity did not affect efficacy of immune-checkpoint inhibitor monotherapy for pretreated patients with advanced non-small cell lung cancer[J]. World J Oncol, 2020, 11(1):9-22. doi: 10.14740/wjon1225 pmid: 32095185
[29]	Kim YY, Lee J, Jeong WK, et al. Prognostic significance of sarcopenia in microsatellite-stable gastric cancer patients treated with programmed death-1 inhibitors[J]. Gastric Cancer, 2021, 24(2):457-466. doi: 10.1007/s10120-020-01124-x URL
[30]	Tsukagoshi M, Yokobori T, Yajima T, et al. Skeletal muscle mass predicts the outcome of nivolumab treatment for non-small cell lung cancer[J]. Medicine (Baltimore), 2020, 99(7):e19059. doi: 10.1097/MD.0000000000019059 URL
[31]	Youn S, Reif R, Chu MP, et al. Myosteatosis is prognostic in Metastatic melanoma treated with nivolumab[J]. Clin Nutr ESPEN, 2021, 42:348-353. doi: 10.1016/j.clnesp.2021.01.009 pmid: 33745604
[32]	Loosen SH, van den Bosch V, et al. Progressive sarcopenia correlates with poor response and outcome to immune checkpoint inhibitor therapy[J]. J Clin Med, 2021, 10(7).
[33]	Magri V, Gottfried T, Di Segni M, et al. Correlation of body composition by computerized tomography and Metabolic parameters with survival of nivolumab-treated lung cancer patients[J]. Cancer Manag Res, 2019, 11:8201-8207. doi: 10.2147/CMAR.S210958 pmid: 31564979
[34]	Deng HY, Chen ZJ, Qiu XM, et al. Sarcopenia and prognosis of advanced cancer patients receiving immune checkpoint inhibitors: A comprehensive systematic review and Meta-analysis[J]. Nutrition, 2021, 90:111345. doi: 10.1016/j.nut.2021.111345 URL
[35]	Wang J, Cao L, Xu S. Sarcopenia affects clinical efficacy of immune checkpoint inhibitors in non-small cell lung cancer patients: A systematic review and meta-analysis[J]. Int Immunopharmacol, 2020, 88:106907. doi: 10.1016/j.intimp.2020.106907 URL
[36]	Quinn LS. Interleukin-15: A muscle-derived cytokine regulating fat-to-lean body composition[J]. J Anim Sci, 2008, 86(14 Suppl):E75-83.
[37]	Lutz CT, Quinn LS. Sarcopenia, obesity, and natural killer cell immune senescence in aging: Altered cytokine levels as a common mechanism[J]. Aging (Albany NY), 2012, 4(8):535-546.
[38]	Tsukamoto H, Fujieda K, Miyashita A, et al. Combined blockade of il6 and pd-1/pd-l1 signaling abrogates mutual regulation of their immunosuppressive effects in the tumor microenvironment[J]. Cancer Res, 2018, 78(17):5011-5022. doi: 10.1158/0008-5472.CAN-18-0118 pmid: 29967259
[39]	Banna GL, Di Quattro R, Malatino L, et al. Neutrophil-to-lymphocyte ratio and lactate dehydrogenase as biomarkers for urothelial cancer treated with immunotherapy[J]. Clin Transl Oncol, 2020, 22(11):2130-2135. doi: 10.1007/s12094-020-02337-3 URL
[40]	Indrakusuma R, Drudi LM. Psoas muscle area and sarcopenia-bridging the gap[J]. Eur J Vasc Endovasc Surg, 2019, 58(2):199. doi: 10.1016/j.ejvs.2019.03.032 URL
[41]	Baracos VE. Psoas as a sentinel muscle for sarcopenia: A flawed premise[J]. J Cachexia Sarcopenia Muscle, 2017, 8(4):527-528. doi: 10.1002/jcsm.12221 pmid: 28675689
[42]	Rutten IJG, Ubachs J, Kruitwagen R, et al. Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer[J]. J Cachexia Sarcopenia Muscle, 2017, 8(4):630-638. doi: 10.1002/jcsm.12180 pmid: 28513088
[43]	Anjanappa M, Corden M, Green A, et al. Sarcopenia in cancer: Risking more than muscle loss[J]. Tech Innov Patient Support Radiat Oncol, 2020, 16:50-57.

作者	发表年份	地区	样本量	肿瘤类型	ICIs种类	诊断指标	测量指标	分界值	结果	质量评价
Dercle^[7]	2016	法国	251	实体瘤	PD-1/PD-L1抑制剂	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	OS	高(8分)
Shiroyama^[8]	2019	日本	42	肺癌	Pembrolizumab Nivolumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	PFS, OS, DCR	高(8分)
Nishioka^[9]	2019	日本	38	肺癌	Pembrolizumab Nivolumab	PMA by CT	腰2-3层面骨骼肌	▲PMA≥ 10% mPMA	PFS, OS, DCR	高(8分)
Cortellini^[10]	2020	意大利	100	实体瘤	Pembrolizumab Nivolumab Atezolizumb others	SMI by CT	腰3层面骨骼肌	男性:48.4 cm²/m² for BMI<25, 50.2 cm²/m² for BMI≥25 女性:36.9 cm²/m² for BMI<25, 59.6 cm²/m² for BMI≥25	PFS, OS, ORR, irAEs	高(7分)
Crombé^[11]	2020	法国	117	实体瘤	PD-1/PD-L1抑制剂	PMI by CT	腰3层面腰大肌	▲PMI<三分位数最小值	PFS	高(7分)
Roch^[12]	2020	法国	142	肺癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:52.4 cm²/m² 女性:38.5 cm²/m² ▲SMI≥5% mSMI	PFS, OS, DCR	高(8分)
Takada^[13]	2020	日本	103	肺癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:25.63 cm²/m² 女性:21.73 cm²/m²	PFS, OS, DCR, ORR	高(7分)
Bilen^[14]	2020	美国	90	实体瘤	NR	SMI by CT	腰3层面骨骼肌	男性:55.97 cm²/m² 女性:37.39 cm²/m²	PFS, OS	高(7分)
Kim^[15]	2020	韩国	102	肝癌	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:42 cm²/m² 女性:38 cm²/m²	PFS, OS, DCR, ORR	高(8分)
Kano^[16]	2020	日本	31	胃癌	Nivolumab	PMI by CT	腰3层面腰大肌	男性:3.6 cm²/m² 女性:2.9 cm²/m²	PFS,DCR,ORR, irAEs	高(7分)
Shimizu^[17]	2020	日本	27	尿路上皮癌	Pembrolizumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m² ▲PMI≥10% mPMI	PFS, OS, irAEs	高(8分)
Fukushima^[18]	2020	日本	28	尿路上皮癌	Pembrolizumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² 女性:25 cm²/m²	PFS,ORR,irAEs	高(7分)
Corellini^[19]	2020	意大利	23	肺癌	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	PFS,OS,ORR, irAEs	高(7分)
Nishioka^[20]	2021	日本	156	肺癌	Pembrolizumab Nivolumab Atezolizumb	SMI和SMA by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	PFS, ORR	高(7分)
Daly^[21]	2017	爱尔兰	84	黑色素瘤	Ipilimumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI < 25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m² ▲SMI≥7.5% mSMI	OS,irAEs	中(6分)
Deike-Hofmann^[22]	2019	德国	147	黑色素瘤	Ipilimumab	PMD by CT	腰3层面腰大肌	45HU(四分位数最小值)	PFS	中(6分)
Chu^[23]	2020	加拿大	97	黑色素瘤	Ipilimumab	SMD by CT	腰3层面骨骼肌	42HU for BMI<25, 20HU for BMI≥25	PFS, OS, DCR, ORR	中(6分)
Hirsch^[24]	2020	法国	92	实体瘤	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	irAEs	中(6分)
Hu^[25]	2020	美国	156	黑色素瘤	Pembrolizumab	PMI by CT	腰3层面腰大肌	男性:5.45 cm²/m² 女性:3.85 cm²/m²	ORR, irAEs	中(6分)
Young^[26]	2020	美国	287	黑色素瘤	Ipilimumab+Nivolumab Pembrolizumab Nivolumab Atezolizumb	SMI和SMD by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25 kg/m², 53 cm²/m² for BMI ≥ 25 kg/m² 女性: 41 cm²/m² 41HU for BMI<25 kg/m², 33HU for BMI≥25 kg/m²	PFS, OS	中(6分)
Akce^[27]	2020	美国	57	肝癌	PD-1抑制剂	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² 女性:39 cm²/m²	PFS, OS	中(6分)
Minami^[28]	2020	日本	74	肺癌	Pembrolizumab Nivolumab Atezolizumb	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	PFS, OS, DCR, ORR	中(6分)
Kim^[29]	2020	韩国	149	胃癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:49 cm²/m² 女性:31 cm²/m²	PFS, OS, DCR, ORR	中(6分)
Tsukgaoshi^[30]	2020	日本	30	肺癌	Nivolumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	ORR	中(6分)
Youn^[31]	2021	加拿大	44	黑色素瘤	Ipilimumab+Nivolumab Nivolumab	SMD by CT	腰3层面骨骼肌	25.65HU	OS	中(6分)
Loosen^[32]	2021	德国	88	实体瘤	PD-1/PD-L1抑制剂	SMI by CT	腰3层面骨骼肌	▲SMI≥6.18 mm²/cm	OS	中(6分)
Magri^[33]	2019	意大利	46	肺癌	Nivolumab	SMI by CT	腰3层面骨骼肌	NR	OS	低(4分)

作者	发表年份	地区	样本量	肿瘤类型	ICIs种类	诊断指标	测量指标	分界值	结果	质量评价
Dercle^[7]	2016	法国	251	实体瘤	PD-1/PD-L1抑制剂	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	OS	高(8分)
Shiroyama^[8]	2019	日本	42	肺癌	Pembrolizumab Nivolumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	PFS, OS, DCR	高(8分)
Nishioka^[9]	2019	日本	38	肺癌	Pembrolizumab Nivolumab	PMA by CT	腰2-3层面骨骼肌	▲PMA≥ 10% mPMA	PFS, OS, DCR	高(8分)
Cortellini^[10]	2020	意大利	100	实体瘤	Pembrolizumab Nivolumab Atezolizumb others	SMI by CT	腰3层面骨骼肌	男性:48.4 cm²/m² for BMI<25, 50.2 cm²/m² for BMI≥25 女性:36.9 cm²/m² for BMI<25, 59.6 cm²/m² for BMI≥25	PFS, OS, ORR, irAEs	高(7分)
Crombé^[11]	2020	法国	117	实体瘤	PD-1/PD-L1抑制剂	PMI by CT	腰3层面腰大肌	▲PMI<三分位数最小值	PFS	高(7分)
Roch^[12]	2020	法国	142	肺癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:52.4 cm²/m² 女性:38.5 cm²/m² ▲SMI≥5% mSMI	PFS, OS, DCR	高(8分)
Takada^[13]	2020	日本	103	肺癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:25.63 cm²/m² 女性:21.73 cm²/m²	PFS, OS, DCR, ORR	高(7分)
Bilen^[14]	2020	美国	90	实体瘤	NR	SMI by CT	腰3层面骨骼肌	男性:55.97 cm²/m² 女性:37.39 cm²/m²	PFS, OS	高(7分)
Kim^[15]	2020	韩国	102	肝癌	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:42 cm²/m² 女性:38 cm²/m²	PFS, OS, DCR, ORR	高(8分)
Kano^[16]	2020	日本	31	胃癌	Nivolumab	PMI by CT	腰3层面腰大肌	男性:3.6 cm²/m² 女性:2.9 cm²/m²	PFS,DCR,ORR, irAEs	高(7分)
Shimizu^[17]	2020	日本	27	尿路上皮癌	Pembrolizumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m² ▲PMI≥10% mPMI	PFS, OS, irAEs	高(8分)
Fukushima^[18]	2020	日本	28	尿路上皮癌	Pembrolizumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² 女性:25 cm²/m²	PFS,ORR,irAEs	高(7分)
Corellini^[19]	2020	意大利	23	肺癌	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	PFS,OS,ORR, irAEs	高(7分)
Nishioka^[20]	2021	日本	156	肺癌	Pembrolizumab Nivolumab Atezolizumb	SMI和SMA by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	PFS, ORR	高(7分)
Daly^[21]	2017	爱尔兰	84	黑色素瘤	Ipilimumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI < 25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m² ▲SMI≥7.5% mSMI	OS,irAEs	中(6分)
Deike-Hofmann^[22]	2019	德国	147	黑色素瘤	Ipilimumab	PMD by CT	腰3层面腰大肌	45HU(四分位数最小值)	PFS	中(6分)
Chu^[23]	2020	加拿大	97	黑色素瘤	Ipilimumab	SMD by CT	腰3层面骨骼肌	42HU for BMI<25, 20HU for BMI≥25	PFS, OS, DCR, ORR	中(6分)
Hirsch^[24]	2020	法国	92	实体瘤	Nivolumab	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25, 53 cm²/m² for BMI≥25 女性: 41 cm²/m²	irAEs	中(6分)
Hu^[25]	2020	美国	156	黑色素瘤	Pembrolizumab	PMI by CT	腰3层面腰大肌	男性:5.45 cm²/m² 女性:3.85 cm²/m²	ORR, irAEs	中(6分)
Young^[26]	2020	美国	287	黑色素瘤	Ipilimumab+Nivolumab Pembrolizumab Nivolumab Atezolizumb	SMI和SMD by CT	腰3层面骨骼肌	男性:43 cm²/m² for BMI<25 kg/m², 53 cm²/m² for BMI ≥ 25 kg/m² 女性: 41 cm²/m² 41HU for BMI<25 kg/m², 33HU for BMI≥25 kg/m²	PFS, OS	中(6分)
Akce^[27]	2020	美国	57	肝癌	PD-1抑制剂	SMI by CT	腰3层面骨骼肌	男性:43 cm²/m² 女性:39 cm²/m²	PFS, OS	中(6分)
Minami^[28]	2020	日本	74	肺癌	Pembrolizumab Nivolumab Atezolizumb	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	PFS, OS, DCR, ORR	中(6分)
Kim^[29]	2020	韩国	149	胃癌	Pembrolizumab Nivolumab	SMI by CT	腰3层面骨骼肌	男性:49 cm²/m² 女性:31 cm²/m²	PFS, OS, DCR, ORR	中(6分)
Tsukgaoshi^[30]	2020	日本	30	肺癌	Nivolumab	PMI by CT	腰3层面腰大肌	男性:6.36 cm²/m² 女性:3.92 cm²/m²	ORR	中(6分)
Youn^[31]	2021	加拿大	44	黑色素瘤	Ipilimumab+Nivolumab Nivolumab	SMD by CT	腰3层面骨骼肌	25.65HU	OS	中(6分)
Loosen^[32]	2021	德国	88	实体瘤	PD-1/PD-L1抑制剂	SMI by CT	腰3层面骨骼肌	▲SMI≥6.18 mm²/cm	OS	中(6分)
Magri^[33]	2019	意大利	46	肺癌	Nivolumab	SMI by CT	腰3层面骨骼肌	NR	OS	低(4分)

组别	HR(95%CI)	P值
肿瘤类型
肺癌	1.57(1.22~2.0)	0.000
黑色素瘤	1.41(0.84~2.38)	0.190
其他	1.73(1.29~2.32)	0.000
ICIs类型
Pembrolizumab	4.0(1.18~13.56)	0.030
nivolumab	1.49(0.88~2.52)	0.013
Ipilimumab	2.12(1.17~3.84)	0.010
其他	1.55(1.22~1.97)	0.000
诊断指标
SMI	1.62(1.33~1.97)	0.000
PMI	1.97(0.88~4.42)	0.100
SMD	1.47(0.79~2.75)	0.230
PMD	-	-
地区
亚洲	1.41(0.98~2.01)	0.060
欧美	1.71(1.31~2.22)	0.000

组别	HR(95%CI)	P值
肿瘤类型
肺癌	1.57(1.22~2.0)	0.000
黑色素瘤	1.41(0.84~2.38)	0.190
其他	1.73(1.29~2.32)	0.000
ICIs类型
Pembrolizumab	4.0(1.18~13.56)	0.030
nivolumab	1.49(0.88~2.52)	0.013
Ipilimumab	2.12(1.17~3.84)	0.010
其他	1.55(1.22~1.97)	0.000
诊断指标
SMI	1.62(1.33~1.97)	0.000
PMI	1.97(0.88~4.42)	0.100
SMD	1.47(0.79~2.75)	0.230
PMD	-	-
地区
亚洲	1.41(0.98~2.01)	0.060
欧美	1.71(1.31~2.22)	0.000

组别	HR(95%CI)	P值
肿瘤类型
肺癌	1.36(0.95~1.95)	0.090
黑色素瘤	1.24(0.97~1.59)	0.090
其他	1.6(1.26~2.02)	<0.01
ICIs类型
Pembrolizumab	2.98(1.53~5.80)	0.001
Nivolumab	1.64(1.06~2.55)	0.030
Ipilimumab	1.63(1.19~2.23)	0.002
其他	1.26(1.04~1.54)	0.020
诊断指标
SMI	1.47(1.22~1.77)	<0.01
PMI	1.87(0.94~3.59)	0.070
SMD	0.97(0.70~1.34)	0.860
PMD	1.67(1.14~2.45)	0.008
地区
亚洲	1.44(1.03~2.01)	0.030
欧美	1.38(1.15~1.66)	0.000