Background The impact of sarcopenia on immune checkpoint inhibitor (ICI) efficacy and treatment-related adverse events (AEs) in gastric cancer (GC) remains controversial. This meta-analysis aims to elucidate associations between sarcopenia and clinical outcomes in ICI-treated GC patients. Methods We systematically searched PubMed, Embase, Scopus, and Web of Science (from inception to May 2, 2025) for English-language studies that met predefined inclusion criteria. Primary outcomes included progression-free survival (PFS) and overall survival (OS) (hazard ratios [HRs] with 95% confidence intervals [CIs]), as well as disease control rate (DCR) and overall response rate (ORR) (odds ratios [ORs] with 95% CIs). Secondary outcomes encompassed treatment-related AEs (ORs with 95% CIs). Heterogeneity was quantified via I² statistics, and sensitivity analyses were performed. Results Thirteen studies (n = 1,119 GC patients) were included. The prevalence of sarcopenia was 54% (95% CI: 46–62%, p < 0.0001; heterogeneity statistics: I2 = 87%, p < 0.0001). Compared to non-sarcopenic patients, sarcopenic patients demonstrated worse OS (adjusted HR = 1.77, 95% CI: 0.67–4.64, p = 0.16; heterogeneity statistics: I2 = 64%, p = 0.04), reduced PFS (adjusted HR = 2.16, 95% CI: 0.88–5.30, p = 0.07; heterogeneity statistics: I2 = 44%; p = 0.14), lower DCR (OR = 0.54, 95% CI: 0.13–2.34, p = 0.33; heterogeneity statistics: I2 = 77%; p = 0.0006), and decreased ORR (OR = 0.69, 95% CI: 0.53–0.89, p = 0.01; heterogeneity statistics: I2 = 0%; p = 0.97). No significant association was observed between sarcopenia and treatment-related AEs (OR = 1.35, 95% CI: 0.38–4.85, p = 0.51; heterogeneity statistics: I2 = 30%; p = 0.23). Conclusion Sarcopenia is prevalent in > 50% of ICI-treated GC patients and may be linked to diminished treatment response and poorer survival outcomes. The absence of increased AE risk supports routine sarcopenia assessment for prognostic stratification in this population. These findings require validation in non-Asian cohorts to establish generalizability.

Sarcopenia Affects the Clinical Efficacy of Immune Checkpoint Inhibitors in Gastric Cancer Patients: a Systematic Review and Meta-Analysis

期刊论文
发表日期：

2026年2月6日

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Fei Zhang,
Ying Yan,
Baifeng Li,
Chunlin Ge,
Yi Wang

摘要

Background

The impact of sarcopenia on immune checkpoint inhibitor (ICI) efficacy and treatment-related adverse events (AEs) in gastric cancer (GC) remains controversial. This meta-analysis aims to elucidate associations between sarcopenia and clinical outcomes in ICI-treated GC patients.

Methods

We systematically searched PubMed, Embase, Scopus, and Web of Science (from inception to May 2, 2025) for English-language studies that met predefined inclusion criteria. Primary outcomes included progression-free survival (PFS) and overall survival (OS) (hazard ratios [HRs] with 95% confidence intervals [CIs]), as well as disease control rate (DCR) and overall response rate (ORR) (odds ratios [ORs] with 95% CIs). Secondary outcomes encompassed treatment-related AEs (ORs with 95% CIs). Heterogeneity was quantified via I² statistics, and sensitivity analyses were performed.

Results

Thirteen studies (n = 1,119 GC patients) were included. The prevalence of sarcopenia was 54% (95% CI: 46–62%, p < 0.0001; heterogeneity statistics: I² = 87%, p < 0.0001). Compared to non-sarcopenic patients, sarcopenic patients demonstrated worse OS (adjusted HR = 1.77, 95% CI: 0.67–4.64, p = 0.16; heterogeneity statistics: I² = 64%, p = 0.04), reduced PFS (adjusted HR = 2.16, 95% CI: 0.88–5.30, p = 0.07; heterogeneity statistics: I² = 44%; p = 0.14), lower DCR (OR = 0.54, 95% CI: 0.13–2.34, p = 0.33; heterogeneity statistics: I² = 77%; p = 0.0006), and decreased ORR (OR = 0.69, 95% CI: 0.53–0.89, p = 0.01; heterogeneity statistics: I² = 0%; p = 0.97). No significant association was observed between sarcopenia and treatment-related AEs (OR = 1.35, 95% CI: 0.38–4.85, p = 0.51; heterogeneity statistics: I² = 30%; p = 0.23).

Conclusion

Sarcopenia is prevalent in > 50% of ICI-treated GC patients and may be linked to diminished treatment response and poorer survival outcomes. The absence of increased AE risk supports routine sarcopenia assessment for prognostic stratification in this population. These findings require validation in non-Asian cohorts to establish generalizability.