The connection between sarcopenia and a patient's response to neoadjuvant treatment remains uncertain. The present study aims to determine if sarcopenia serves as a predictor of overall complete response (oCR) after Total Neoadjuvant Therapy (TNT) for advanced rectal cancer.
In South Australia, three hospitals observed patients with rectal cancer receiving TNT between 2019 and 2022 within a prospective observational study. The diagnosis of sarcopenia was made by evaluating pretreatment computed tomography data of psoas muscle cross-sectional area at the third lumbar vertebra level, adjusted for patient height. The key measure was the occurrence of oCR, representing the fraction of patients who achieved either a clinical complete response (cCR) or a pathological complete remission.
A study of 118 rectal cancer patients, with an average age of 595 years, included 83 patients (703%) who belonged to the non-sarcopenic group (NSG) and 35 patients (297%) who were classified as sarcopenic (SG). A statistically significant difference (p < 0.001) was observed in OCR rates, with the NSG group exhibiting a noticeably higher rate compared to the SG group. The NSG group experienced a substantially greater cCR rate when compared to the SG group, a statistically significant difference (p=0.0001). Multivariate statistical analysis indicated sarcopenia (p=0.0029) and hypoalbuminemia (p=0.0040) as risk factors for complete clinical remission (cCR). Sarcopenia was identified as an independent predictor of objective clinical remission (oCR) with a p-value of 0.0020.
Sarcopenia and hypoalbuminemia were inversely correlated with tumor response to TNT in a cohort of advanced rectal cancer patients.
In advanced rectal cancer patients undergoing TNT therapy, a detrimental influence of sarcopenia and hypoalbuminemia on tumor response was observed.

The Cochrane Review, from Issue 2, 2018, has been updated; this is the revised edition. learn more An uptick in endometrial cancer diagnoses is linked to the surge in obesity cases. Obesity contributes to endometrial cancer by creating a condition of unopposed estrogen dominance, insulin resistance, and inflammation. Surgical procedures and radiotherapy regimens are further complicated, along with an increased chance of complications, potentially diminishing long-term survival due to this factor. Interventions focused on weight loss have been correlated with better survival rates for breast and colorectal cancers, and with a decreased risk of cardiovascular disease, a significant cause of mortality among endometrial cancer survivors.
Investigating the gains and losses associated with weight-loss therapies, in addition to established care, regarding survival rates and the rate of adverse events in overweight and obese endometrial cancer patients compared to other interventions, standard practice, or placebo.
Our approach involved a comprehensive Cochrane search, employing established methodologies. The period considered for this review comprised search data from January 2018 up to June 2022. The previous review, in contrast, utilized the entire dataset available, starting from the beginning and ending with data from January 2018.
We examined randomized controlled trials (RCTs) focusing on interventions to facilitate weight loss in overweight or obese women with endometrial cancer, either currently or formerly treated for the condition, in comparison with alternative treatments, usual care, or a placebo. Data collection and analysis were executed in strict adherence to Cochrane's guidelines. The principal endpoints of our study were 1. patient survival and 2. the rate of adverse occurrences. Our secondary outcome measures included 3. recurrence-free survival, 4. cancer-specific survival, 5. weight loss, 6. the frequency of cardiovascular and metabolic events, and 7. quality of life. To evaluate the dependability of the evidence, we employed the GRADE assessment. We sought the missing data from the study authors, including specifics regarding any adverse events.
In our updated review, nine newly recognized RCTs were incorporated alongside the three RCTs from the prior review. Seven separate studies are progressing. A total of 610 women, identified as overweight or obese, and suffering from endometrial cancer, were involved in the 12 randomized controlled trials. Across all included studies, the effectiveness of combined behavioral and lifestyle interventions, aimed at weight loss through dietary modifications and heightened physical activity, was assessed against usual care. learn more The quality of the included RCTs was suboptimal (low or very low) due to a high probability of bias from the unblinding of participants, personnel, and outcome assessors, along with an important loss to follow-up (a participant attrition rate of up to 28% and missing data up to 65%, largely driven by the effect of the COVID-19 pandemic). Crucially, the brief period of follow-up hinders the certainty of the evidence when assessing the effect of these interventions on long-term outcomes, including survival. Lifestyle and behavioral interventions, when combined, did not demonstrate improved overall survival rates at 24 months compared to standard care (risk ratio [RR] for mortality: 0.23; 95% confidence interval [CI]: 0.01 to 0.455; p = 0.34). This finding was based on a single randomized controlled trial (RCT) involving 37 participants, yielding very low-certainty evidence. A lack of improvement in cancer-specific survival or cardiovascular health was found with the applied interventions. No cancer deaths, heart attacks, strokes were recorded, and a solitary case of congestive heart failure after six months occurred, supporting the lack of efficacy (RR 347, 95% CI 0.15 to 8221; P = 0.44, 5 RCTs, 211 participants; low-certainty evidence). One randomly controlled trial assessed recurrence-free survival; however, no events of interest were observed. When behavioral and lifestyle changes were implemented together, no significant weight loss was observed at six or twelve months, in comparison to the control group receiving standard care (mean difference -139 kg, 95% CI -404 to 126 at six months; P = 0.30).
Low-certainty evidence, derived from five randomized controlled trials (209 participants), made up 32% of the total. Combined behavioral and lifestyle interventions did not correlate with increased quality of life at 12 months, as measured by the 12-item Short Form (SF-12) Physical Health questionnaire, SF-12 Mental Health questionnaire, Cancer-Related Body Image Scale, Patient Health Questionnaire 9-Item Version, or Functional Assessment of Cancer Therapy – General (FACT-G), when compared to patients receiving usual care.
Two RCTs, comprising 89 participants, provide evidence which is highly uncertain and not supported, resulting in a zero percent confidence level. In the trials examining weight loss interventions, no severe adverse events, such as hospitalizations or deaths, were identified. A question remains about the possible effect of lifestyle and behavioral interventions on musculoskeletal symptoms, given the very low certainty of the evidence, with no notable difference observed between groups (RR 1903, 95% CI 117 to 31052; P = 0.004; 8 RCTs, 315 participants; note 7 studies reported musculoskeletal symptoms, but recorded zero events in both groups). In this way, the relative risk and confidence intervals were produced from a single study rather than from the aggregate findings of eight studies. In spite of the inclusion of further pertinent studies, the authors' review conclusions are unchanged. To date, high-quality evidence is insufficient to determine the consequences of combined lifestyle and behavioral interventions on survival, quality of life, or significant weight loss in overweight or obese endometrial cancer survivors, relative to those receiving routine care. From the available and restricted data, there's an indication of few, if any, significant or life-threatening adverse reactions from these interventions. The question of whether musculoskeletal issues rose is unresolved, given that only one out of eight studies reporting on this area witnessed any such occurrences. Our conclusion is founded upon low and very low certainty evidence, drawn from a small number of trials and including only a few women. Consequently, our confidence in the evidence regarding the true impact of weight-loss interventions on women with endometrial cancer and obesity is exceptionally low. RCTs with a five to ten year follow up period, methodologically rigorous and adequately powered, are required to advance our understanding. Weight loss interventions, including dietary adjustments and medications, coupled with bariatric surgery, significantly affect patient survival, quality of life, and the frequency of adverse events.
Nine new RCTs were identified, alongside the three already present in the initial review. learn more Currently, seven research studies are in progress. Twelve separate randomized controlled trials involved the recruitment of 610 women affected by endometrial cancer, who were characterized as overweight or obese. A meta-analysis of all the studies involved comparing combined behavioral and lifestyle interventions for weight loss, achieved by altering diets and increasing physical activity, with the typical level of care. The included RCTs displayed low or very low quality, attributable to substantial risks of bias inherent in the lack of blinding of participants, personnel, and outcome assessors, compounded by a substantial loss to follow-up (withdrawal rates up to 28% and missing data up to 65%, largely as a consequence of the COVID-19 pandemic). The brief duration of follow-up observation significantly restricts the ability to precisely determine the long-term implications of these interventions on various outcomes, including survival. At the 24-month mark, the integration of behavioral and lifestyle interventions did not yield a statistically significant improvement in overall survival in comparison to usual care (risk ratio [RR] mortality: 0.23; 95% confidence interval [CI]: 0.01 to 0.455; P = 0.34). This conclusion, derived from a single randomized clinical trial (RCT) with 37 subjects, is underpinned by very low-certainty evidence. A review of the interventions’ impact on cancer-related survival and cardiovascular events found no compelling evidence of benefit. Critically, the trials did not record any cancer deaths, heart attacks, or strokes; just a single case of congestive heart failure at six months. The evidence, based on 211 participants across five randomized controlled trials, is considered of low certainty. This yields a relative risk of 347 (95% confidence interval 0.015-8221) and a p-value of 0.44.