151751-Najiba-Chargi

239 Systemic therapy: skeletal muscle mass and anti-cancer drug toxicity ASSESSMENT OF RISK OF BIAS The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. 19 The QUIPS tool assesses the risk of bias based on six domains each with multiple sub-domains. Each sub-domain is rated with “yes”, “no”, “partial”, or “unsure” after which each domain is rated low, moderate, or high based on the ratings of the sub-domains. The six domains are (1) study participation, (2) study attrition, (3) prognostic factor measurement, (4) outcome measure - ment, (5) study confounding, and (6) statistical analysis and reporting. 19 A study was scored as low risk of bias when at least four domains were rated as low, and a maximum of two domains was rated moderate (of which prognostic factor measurement and outcome measurement must be rated low), with no domains rated as high. A study was scored as high risk of bias if more than two domains were rated high, or four domains were rated moderate. All remaining studies were scored as a moderate risk of bias. DATA ANALYSIS A meta-analysis was performed using Review Manager (Revman v5.3, The Nordic Cochrane Collaboration, Copenhagen, Denmark, 2014). A random-effects model was used because of the assumed heterogeneity between the studies. Studies were excluded from the meta-analysis if (1) there was insufficient data to calculate an odds ratio (OR); (2) low SMM was not defined with a cut-off value, and SMI was instead used as a continuous variable; or (3) the endpoint for toxicity did not match any other studies, hampering combination with other studies for meta-analysis. The results were visualized using forest plots expressed in OR with 95% confidence interval (CI). The results were stratified for toxicity definition, namely, toxicity ≥ grade 3 according to Common Terminology Criteria for Adverse Events (CTCAE) and dose-limiting toxicity (DLT). Further stratification was based on cut-off values, measurement technique, and vertebrae level analysed. Heterogeneity was assessed with the χ 2 and I2 statistic tests. I2 values between 25% and 50%were considered to demonstrate low heterogeneity, 50% to 75% demonstrates moderate heterogeneity, and >75%was considered to demonstrate high heterogeneity. Sub - group analysis was performed for any monotherapy which was used in the populations of more than one study. p-values < 0.05 were considered statistically significant. RESULTS SEARCHRESULTS The search yielded 906 hits. One additional study was included after the screening of all included articles reference lists. After the removal of 357 duplicates, the titles and abstracts of 550 studies were screened. The screeningof abstracts and titles yielded52 studies for full-text screening. After the full-text screening, 31 met all inclusion criteria and were included in this review. 5–8,16,20–45 The selection process with exclusion reasons is shown in Figure 1. A total of 19 studies were included in the meta-analysis. Studies were excluded from the meta-analysis because the study did not 13