Search Results and Study Characteristics

After removing duplicates, 2,567 abstracts were screened. Ultimately, 280 studies with 81,885 patients (roughly 58% men, 42% women) were included. Mean patient age was around 62 years, slightly higher in European cohorts. Most studies (69%) were retrospective.

By region, 107 studies originated in Europe (16,061 patients), 42 in North America (19,257 patients), and 131 in Asia (45,567 patients). The largest sample sizes concerned colorectal (44 studies, 32,823 patients) and gastric cancers (35 studies, 9,950 patients). Some entities, such as endometrial cancer or gastrointestinal stromal tumors (GIST), had only one or two included studies.

QUADAS-2 revealed low-to-moderate risk of bias overall. Egger’s test (p=0.001) indicated possible publication bias, suggesting underreporting of smaller or null-result studies.

Overall Prevalence of Sarcopenia

Across all patients and tumor types, the pooled sarcopenia prevalence was 35.5%. However, clear geographic differences emerged:

• Europe (107 studies): 45.6% overall prevalence. Entities with especially high rates (>50%) included prostate, renal, pancreatic, lung, and esophageal cancers.
• North America (42 studies): 41.2% overall prevalence. Urothelial cancer (58.2%) and prostate cancer (55.6%) had the highest estimates.
• Asia (131 studies): 29.6% overall prevalence. Prostate cancer showed very high rates (78.4%) in certain subgroups, while colorectal cancer was often lower (~16% in some cohorts).

Differences also surfaced when splitting cohorts by curative versus palliative intent:

• Curative setting: 43.7% in Europe, 41.2% in North America, 37.4% in Asia.
• Palliative setting: 55.7% in Europe, 36.5% in North America, 45.7% in Asia.

European studies in palliative populations tended to show notably high rates, exceeding 70% in some advanced esophageal and prostate cancer cohorts.

By Cancer Type

Prostate Cancer

• Europe: 60.3% overall.
• Asia: 78.4% (mostly palliative or advanced disease).
• North America: 55.6%.The high prevalence is consistent with known muscle depletion from androgen deprivation therapy.

Pancreatic Cancer

• Europe: ~56%.
• North America: ~54%.
• Asia: ~34%.Pancreatic cancer is known for its strong association with cachexia, though geographic variations are striking.

Esophageal Cancer

• Europe: 55.8% overall, rising to >70% in palliative subgroups.
• Asia: 53.8%.Both show a large sarcopenic burden, especially in advanced disease.

Colorectal Cancer

• One of the most heavily studied, with 44 included papers and ~32,823 patients.
• Overall prevalence: ~28.5% globally, but in Europe and North America it reached 40–42%, whereas in some Asian series it was ~16%.

These differences may reflect population demographics, dietary factors, or region-specific screening practices.