The prognostic utility of temporalis thickness measured on MRI scans in patients with intra-axial malignant brain tumours: a systematic review and meta-analysis

Abstract

Sarcopenia is associated with worsened outcomes in solid cancers [1].
Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia
[2]. Hence, this study aims to evaluate the relationship between TMT
and outcome measures in patients with malignant intra-axial neoplasms.
We searched Medline, Embase, Scopus, and Cochrane databases for relevant
studies. Event ratios with 95% confidence intervals (CI) were analysed
using the RevMan 5.4 software. Where meta-analysis was impossible, vote
counting was used to determine the effect of TMT on outcomes. The
GRADE framework was used to determine the certainty of the evidence.

Four outcomes were reported for three conditions across 17 studies
involving 4430 patients. Glioblastoma: thicker TMT was protective for
overall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progression
free survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high),
and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989)
(GRADE high); there was no association with complications (HR 0.82;
95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMT
was protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate);
there was no association with PFS (GRADE low). Primary CNS
lymphoma: TMT was protective for overall survival (HR 0.34; 95%
CI 0.19–0.60) (GRADE moderate) and progression free survival (HR
0.23; 95% CI 0.09–0.56) (GRADE high).
Across various intracranial intra-axial malignancies, patients with
thicker TMT have better survival outcomes and are less prone to discontinuing
treatment secondary to drug toxicity. TMT has the potential to
be a valuable prognostic tool for risk-benefit considerations in the management
of these patients.