This meta-analysis is the first to compare CT-defined sarcopenia in cancer patients across multiple regions (Europe, North America, Asia), encompassing 280 studies and over 80,000 individuals. Our findings confirm that while sarcopenia occurs in roughly one-third of all cancer patients overall, regional prevalence varies substantially.

Regional DisparitiesEurope consistently showed higher overall prevalence (45.6%) than Asia (29.6%) or North America (41.2%). Possible explanations include demographic differences (older average age and higher prevalence of comorbidities in certain European cohorts), lifestyle factors (lower physical activity in some Western populations), and diverse definitions of CT-based sarcopenia. Moreover, healthcare systems differ in screening, management strategies, and supportive care for high-risk groups.

Curative vs. Palliative ContextPalliative populations demonstrated higher sarcopenia rates in every region, especially in Europe. Disease progression and more intensive treatments in advanced disease could exacerbate muscle wasting. This observation underscores the clinical value of routine muscle assessment in metastatic or unresectable malignancies, particularly in settings where data point to consistently high sarcopenia burden (e.g., advanced prostate or esophageal cancer in Europe).

Cancer-Type VariationsSome malignancies showed consistently elevated prevalence across regions (pancreatic, esophageal, and prostate cancer). Others (colorectal cancer, HCC) had more divergent results. These differences emphasize that tumor biology, treatments (e.g., ADT in prostate cancer), and comorbidity profiles also shape sarcopenia risk.

Clinical Implications

1. Screening: Routine CT-based muscle mass evaluation may identify patients at increased risk of complications, including higher chemotherapy toxicity and worse survival. Many patients already undergo staging scans, so measuring muscle area at L3 is both feasible and cost-effective.
2. Therapeutic Interventions: Evidence supports nutritional optimization and resistance exercise programs to mitigate sarcopenia. High-prevalence settings, particularly advanced pancreatic or esophageal cancer, may warrant early and aggressive interventions.
3. Cutoff Standardization: Although L3-based muscle measurement is widely used, numerical SMI thresholds differ across studies. A universal cutoff or region-adapted reference ranges would improve data comparability and guide clinicians more reliably.
4. Future Research: Additional prospective trials with uniform sarcopenia definitions are needed. Large-scale studies should consider genetic and ethnic differences within broad geographic regions, explore subtypes of sarcopenia (e.g., sarcopenic obesity), and clarify how interventions can be tailored.

LimitationsOur findings must be interpreted within certain constraints:

• We limited our analysis to English-language studies, potentially underrepresenting South American or African data.
• Most included studies were retrospective.
• Different numeric cutoffs for defining LSMM create inherent heterogeneity.
• Some cancer types had limited data (endometrial cancer, GIST).
• We could not fully account for ethnicity, which may vary within each continental region.

Despite these issues, the large sample size (over 80,000 patients) and exclusive use of CT-derived SMI at L3 strengthen our conclusions.

In this meta-analysis of 280 studies, the overall sarcopenia prevalence in solid tumors was 35.5%, but rates varied markedly by region. Europe showed the highest prevalence (45.6%), followed by North America (41.2%) and Asia (29.6%). Palliative cohorts consistently exhibited higher sarcopenia proportions, exceeding 55% in European advanced cancers. Entities like prostate, pancreatic, and esophageal cancers frequently displayed elevated rates across regions.

Our results highlight the importance of region-specific screening and supportive interventions, as well as the need for consistent diagnostic thresholds. Given the clinical impact of sarcopenia—ranging from increased therapy toxicity to reduced survival—routine assessments of muscle mass could significantly improve oncologic care. Future work should standardize diagnostic cutoffs, explore the influence of ethnicity, and test tailored interventions to mitigate muscle loss and its detrimental effects.