Knowledge mapping and visualization of current sarcopenia and cancer research: a bibliometric analysis
Beni-Suef University Journal of Basic and Applied Sciences volume 12, Article number: 51 (2023)
Cancer survivors face broad challenges in weight loss due to multiple factors. Sarcopenia prevalence among cancer survivors has a wide range and is associated with worse outcomes. Sarcopenia and cancer attract global attention. The use of bibliometrics analysis in this area of interest still needs to be identified. This study was performed to assess the global trends and patterns of sarcopenia and cancer-related scientific publications.
Web of Science (WOS) and articles indexed in Science Citation Index Expanded. VOS viewer (Leiden University, Leiden, Netherlands) and R-studio using bibliometrics and R package were used for quantitative analysis of the dataset (year of publications, number of publications, institutes, journals, total citations, H-index status, authors, hotspots of institutes, Keywords, research area, and funding sponsor.
Our analysis extracted 384 publications from 172 journals written by 2525 authors from the Institute for Web of Science Core Collection database. Overall, 384 articles from the WOS database met the inclusion criteria. The number of published papers has risen since 2014. The results showed that Japan, China and the USA contributed the most to this field. Moreover, our results recognized future research trends and the current condition of sarcopenia and cancer research based on the top 10 most cited articles and the keyword analysis. Finally, the leading author's analysis demonstrated that Shen Xian from Wenzhou Medical University, China, Baracos and Vickie E from the University of Alberta, Switzerland, were the most productive, active, and influential authors.
Our study demonstrates a comprehensive and objective overview of the up-to-date status of sarcopenia and cancer research. These data would benefit scholars who need information on sarcopenia and cancer research. It would be a reference guide for researchers wanting to conduct additional studies related to the topic.
Cancer is the second principal cause of death globally . However, cancer treatments have improved significantly, leading to an expanded life span post-diagnosis and an increasing number of advanced cancer survivors . That may be due to the advances in early detection methods and treatment and the ageing and growth of the population using advanced applications [3, 4].
During cancer treatment, the patient often faces broad challenges in weight loss caused by protein-calorie malnutrition (PCM) . Sarcopenia within cancer patients could be referred to as α-motoneuron loss, increased interleukin-6 secretion (IL-6), and inhibition of growth hormone secretion, in addition to treatment-related factors such as inactivity and malnutrition [7,8,9]. These accumulated factors could result in substantial muscle wasting by suppressing appetite and activating the ubiquitin–proteasome and Nuclear factor-κB (NF-Κb) pathway , increasing challenges to prevent and treat sarcopenia. Sarcopenia is commonly associated with worse outcomes, including progressive frailty, falls, fractures, physical limitation and death . An earlier study found sarcopenia prevalence among cancer survivors ranged from 14 to 79% . Scholars found sarcopenia is more prevalent in cancer patients and related to adverse surgical results. They were additionally associated with elevated incidence of chemotherapy-induced cytotoxicity and worse prognosis.
Although no medical intervention has been explored or identified to treat this disease, malnutrition extensively affects outcomes in cancer patients. Earlier studies confirmed that malnutrition was common in cancer patients, e.g. gastric, pancreatic, lung, prostate, and colon cancer, with incidences varying from 30 to 85% . Complications in cancer patients are hard to maintain unless they have a sufficient dosage of vitamins and minerals [12, 13]. Those survivors require dietary supplements that contain anti-inflammatory, anticancer, antioxidant, and immunomodulatory properties . Furthermore, exercise and physical activity are crucial for cancer survivors during their journey of treatment and post-therapy . Exercise prevents muscle breakdown by restoring redox homeostasis by increasing the production of antioxidants and anti-inflammatory rather than pro-oxidants as exercise training increases IL-6, IL-10 and IL-1ra while reducing tumour necrosis factor alpha (TNF-alpha) .
The area of sarcopenia and cancer has recently become a research point of interest. Many scholars paid much more attention and effort to the fields by covering broad topics , predicting postoperative infections and inpatient rehabilitation , monitoring sarcopenia status in overweight or obese patients with late-stage of pancreas cancer  and cancer-associated malnutrition in the elderly . The use of bibliometrics is a particular sort of quantitative and qualitative analysis used by many scholars. It comprehensively analyses the research trends, research productivity and authorship achievement of current status. So the techniques have played a significant role in the past years among scholars [4, 20,21,22,23,24,25,26,27,28,29,30,31,32], with an enormous explosion of scientific publications and research over the past few decades due to the rapid growth in electronic databases, bibliometrics has become an essential instrument for tracking trends in scientific research [33, 34]. The bibliometric study helps to cover the majority of scientific results and supports the policymaking and better understanding of scientific fields [23, 25, 27, 28, 35,36,37,38,39].
This study aimed to intuitively show the global research trends in research on knowledge structure based on sarcopenia and cancer-related publications indexed in the Web of Science database by using a bibliometric analysis as a newly developed visualization tool. These investigations will help scientific researchers understand the research status and frontier trends better. Furthermore, the results could present helpful knowledge and quantitative insights to future researchers to understand the surge in research output associated with sarcopenia and cancer-related publications for further investigation and publication.
2 Main text
2.1 Materials and methods
2.1.1 Study design
Bibliometric investigation methods based on Knowledge mapping were developed as an essential part of mining tools to evaluate the global trends of sarcopenia's influence and innovation patterns in cancer patients-related scientific publications.
2.1.2 Data sources
Metadata of the sarcopenia in cancer patients-related publication were collected from the Web of Science (WOS) Core Collection, editions Science Citation Index Expanded (SCI-Expanded) was used for the study (https://www.webofscience.com/) as is used as an information retrieval platform, and the Journal Citation Reports (https://jcr.clarivate.com/jcr/home) were both accessed on October 1, 2022. WOS is the most acknowledged and appropriate database for subsequent bibliometric analysis over the past years that enables users to search current and retrospective multidisciplinary information from over 12,000 research journals globally; besides it provides scholars with the most influential and credible information, it is delivered to assess the trends and citation graphically, search across all authors and author affiliations, identify trends and publication patterns through used quantitative analysis techniques [20, 21, 28, 38, 40,41,42].
2.1.3 Search strategy
The search was developed using mesh terms for Cancer and Sarcopenia as follows: “Cancer” (Title) or “Benign neoplasms” (Title) or “malignancy” (Title) or “malignant neoplasms” (Title) or “neoplasia neoplasm” (Title) or “neoplasms” (Title) or “benign” (Title) or “tumours” (Title) AND “sarcopenia” (Title).
Two independent researchers reviewed and evaluated the cited articles. Original and reviewed articles were included in the study, while our finalized data set excluded meeting abstracts, letters, editorial materials, and corrections. In addition, the language of publications is limited to English, while other publications published in French, German, and Spanish were excluded. Finally, a total of 384 valid publications on sarcopenia in cancer patients from the retrieval results are kept and saved. These publications include the bibliographical information such as (year of publications, citation of the publications, authors, journal, institution, countries or region, research area, funding organizations, references, and keywords) which were identified and exported as Bib TeX or CSV file or plain text or tab-delimited file format for further analysis (Fig. 1).
2.1.4 Data analysis
Quantitative analysis was conducted using R-Studio, a free and open-source development environment of R run on the windows operating system. The Bibliometrics package was used for data analysis and interpretation . And the VOS viewer (version 1.6.6) package program (Leiden University, Leiden, The Netherlands) was used for mapping and visualization of the co-authorship and co-citation networks . All statistical analysis was performed using SPSS version 19.0 for windows. The p-value < 0.05 was considered statistically significant.
2.2.1 Evolution and current status of scientific research
Overall, 384 documents were published till December 2021. Overall, 324 articles accounting for 84.37%, and 60 review papers accounting for 15.62% of selected publications, were included in the final analysis. The first article on sarcopenia and cancer-related publications were published in 2005, and very little enhancement was found in the following ten years. There was a small peak in the number of studies in 2015 (n = 12). Then, scholars' attention to sarcopenia, and cancer research gradually increased sarcopenia and cancer subjects, which led to a jump in publications number in 2019 to (n = 59) articles, followed by 2020 to (n = 71) articles, and in 2021 to (n = 104) articles (Fig. 2).
2.2.2 Characteristics and H-index analysis of articles
According to the data analysis selected from WOS, all sarcopenia and cancer-related publications were cited 12,970 times in total, 4997 times cited without self-citations, and h-index 57. Of 172 sources, 635 Affiliations, 33 webs of science categories, 261 funding agencies were contributed by 2525 authors with 8.41 Co-Authors per article and 15.36 International co-authorships (Table 1).
2.2.3 Top cited articles
Analysis of the top 10 most cited articles in sarcopenia in cancer patients-related publications based on the number of received citations is depicted in Table 2. The top 10 articles range from 164 to 691 times. The top cited articles were published in 2009 entitled “Sarcopenia as a determinant of chemotherapy toxicity and time to tumour progression in metastatic breast cancer patients receiving capecitabine treatment”.
2.2.4 Author’s analysis
The top 10 most productive authors on sarcopenia and cancer-related publications are shown in Table 3. Shen Xian from Wenzhou Medical University, China, published the most significant number of articles (11, 2.86%), followed by Zhuang, Cheng-Le from Tongji University, China, with published (10, 2.58%), and Baracos, Vickie E from the University of Alberta, Switzerland (9, 2.34%). Of the top 10 authors, five were from China; two were from South Korea (Table 3).
2.2.5 Annual publication and country collaboration analysis
Eligible publications were published in 32 corresponding authors' countries. The details of the single-country publication (SCP) collaboration and multiple-country publications (MCP) are reported in (Table 4). Japan is the leading corresponding author's Country for research in sarcopenia and cancer-related publications, with 74 articles, followed by China with 70 articles. Details on the annual trends of the number of articles per country that vary over the years are presented in Fig. 3A, and inter-state relations between the countries that contributed to sarcopenia and cancer patients-related publications at the level of international collaboration are shown in Fig. 3B.
2.2.6 Distribution of published journals
A total of 384 articles were published in 172 journals. The ten most popular journals in sarcopenia and cancer-related research are presented in Table 5. The number of publications from the top 10 journals accounts for 102 (26.56%) articles. The journal with the most significant publications was Annals of Surgical Oncology, with 15 articles, followed by Clinical Nutrition, with 15 articles making the most positive contributions to the field. The top 10 Journals focus on oncology, nutrition & dietetics, Geriatrics & Gerontology, and Health Care Sciences & Oncology, reflecting the close links between sub-topics of sarcopenia and cancer-related publications.
2.2.7 Top institutes, web of science categories, and funding sponsors
The top 10 most creative institutions, web of science categories, and funding sponsors contributed to sarcopenia and cancer, summarized in Table 6. Wenzhou Medical University published the highest article number (20, 5.20%); then, the University of Alberta (13, 3.38%) and Tongji University (12, 3.12%) of 33 subject areas reported during the study period. Most of the sarcopenia and cancer-related publications were indexed in the area of Oncology (176, 45.83%), followed by Nutrition Dietetics (55, 14.32%), and Gastroenterology Hepatology (30, 7.813%). Of 261 organizations that supported and enhanced publication productivity (The National Institutes of Health NIH USA) is among the leading organizations contributing to (25, 6.51%) articles.
2.2.8 Keywords analysis and research hotspots
Keywords reflect an article's core content and ideas, and the frequency of the co-occurrence could reveal the research hotspots for sarcopenia and cancer-related publication to support the research effectively—Fig. 4A shows the annual trends of the author's Keywords, which deeply provide a reference for follow-up research on sarcopenia and cancer-related publications. Moreover, in Word cloud of the most frequently top 100 Keywords Plus analysed using biblioshiny, we derived the top 10 keywords Plus (in order of highest frequency). Only the top 10 were listed as “body composition” (122), followed by “survival” (97), “skeletal-muscle” (95), “Obesity” (84), “cachexia” (78), “impact” (73), “resection” (70), “outcome” (68), “prevalence” (65), and “chemotherapy” (56), among others (Fig. 4B).
2.2.9 The conceptual structure analysis using a topic dendrogram
Clustering analysis is a technique to understand better the similarity based on the co-occurrence of two keywords. A dendrogram presented in our analysis to shows the relationships between objects associated with each other; here, we display the occurrences of the 50 Authors' Keywords, Keywords Plus, and the title arrangement of clusters formed by the corresponding analysis, which might successfully reveal the research hotspots and provide research support. Multiple factorial approaches, including multiple corresponding analyses (MCA), are used to reduce data dimensionality. MCA is a new statistical technique gaining attractiveness in the medical field. This method reduces the number of dimensions in data, resulting in two-dimensional visualizations that show the similarities between data as well as shown in Keywords Plus (Fig. 5A), Authors Keywords (Fig. 5B), and Title (Fig. 5C).
2.2.10 Co-authorship analysis
Co-authorship analysis was analysed using VOS viewer. In total, 121 authors (minimum number of documents of an author: 3) were analysed based on the total Link strength between authors in three clusters (TLS = 214) times (Fig. 6B). Yu Zhen (TLS = 56), followed by Zhuang Chen-Le (TLS = 56), Shen Xian (TLS = 51), and Chen Xiao-Lei (TLS = 45) times (Fig. 5A). In total, 28 countries (minimum number of documents of an author: 3) were analysed based on the total Link strength between authors in seven clusters (TLS = 104) times. The USA is top rank with TLS = 33, followed by Germany (TLS = 21), Italy (TLS = 18), Canada (TLS = 16), and Austria (TLS = 14), among others (Fig. 6B).
To the authors' knowledge, this is the first bibliometric analysis of sarcopenia and cancer-related research from a document indexed on the Web of Sciences. Science Citation Index Expanded (SCI-EXPANDED) was included. The study aims to provide a comprehensive overview of the global sarcopenia and cancer-related research knowledge structure and research hots in the fields from 2005 to 2021, of 384 published articles reported. The trend analysis has seen an explosion in sarcopenia and cancer research, covering many research areas, including Oncology, Surgery, and Nutrition Dietetics. The significant development in the field contributed to over 172 academic journals, 2525 authors from more than 32 corresponding author's countries, and 15.36 International collaborations between the co-authorships within this field.
In our study, the result illustrated little more active scientific research productivity globally between the years 2005–2012. The number of sarcopenia and cancer research publications has risen recently, in particular from 2015 to 2021. This trend suggests that sarcopenia and cancer research development has rapidly progressed and attracted more interest in the global scientific medical society. Thus, the finding confirms the previously published study on international sarcopenia research, which shows the rapid increase in publications over the past years from 2001 to 2020 .
The increasing number of articles published annually may be the fund support to enhance the global scientific sarcopenia and cancer research publications. The findings of the top 10 leading articles, within them two highly cited research, provide an overview of sarcopenia and its association with body mass index (BMI)in renal cancer patients  and obesity associated with adverse prognostic factors in pancreatic cancer . Published articles with the highest citation frequency are related to correlating academic impacts in sarcopenia and cancer-related research field. Comprehensive information refereed to the top ten most frequently cited articles on sarcopenia and cancer-related research is provided in Table 2, and the association between different types of cancer are also reported, such as Breast Cancer, Pancreatic Cancer, Colorectal cancer, Gastric Cancer, Bladder Cancer, and other factors such as Cancer-associated malnutrition, and body mass index [16,17,18,19, 46,47,48,49,50,51].
The findings of the analyses show the most prolific countries confirmed that highly contributed to sarcopenia and cancer research publications are being conducted worldwide. More importantly, Japan is listed among the world's top-ranking corresponding author countries, followed by China and the USA. Thus findings reflect the outcome of the other published work where the USA is the top leading research country in global research trends in sarcopenia . In addition, the findings show that most funds for research originated from the National Institutes of Health, which has supported research in this field.
Our analyses of the most prolific institutions confirmed that sarcopenia and cancer-related research are being conducted worldwide. More importantly, Wenzhou Medical University, China, is the first-world institution that contributes the most to sarcopenia and cancer-related. These may be the most developing countries with significant institutions and funding organizations that have supported research in this field to enhance research development.
On the other hand, understanding the characteristics of highly cited studies in a journal could guide the authors who desire to submit and publish their work efficiently. It is the most popular accepted method to assess the qualities of a particular field.
The data from this study indicated that 172 peer review journals related to the subject contributed to the publishing of 384 articles. Annals of surgical oncology and Clinical Nutrition was the leading journal with more than ten articles. Most of the 96.35% of the research was published in Oncology, Surgery, Nutrition Dietetics, Gastroenterology hepatology, and general medicine Internal. The analysis also shows the cooperation degree and cooperation between countries based on the links between the reported countries (Fig. 3B).
Despite its first comprehensive bibliometric study on global sarcopenia and cancer-related publication indexed in the Web of Sciences Database, our study has some limitations on the methodological quality of our study, which can be considered as scope for future research for those interested in the field. First, this study screened the WOS database for global sarcopenia and cancer-related publications. Therefore, this study did not include articles not indexed in Scopus, Google, and PubMed. In the future, researchers may need to consider those databases. Second, we include articles published in English, so we have yet to include other document types published in non-English in the analysis. Thus, in the future, researchers must also consider including other languages. Thirds, we excluded publications of the year 2022 from the study. In the future, therefore, we need also to consider the period and pay much more attention to sarcopenia and cancer latest publications.
In this study, we assessed the global sarcopenia and cancer-related publication indexed in the Web of Sciences database published from 2005 to 2021 to provide detailed information on sarcopenia and cancer-related publication for interested scientists and scholars globally. Regarding our results, developing nations are lagging in sarcopenia and cancer-related publications with active research productivity after 2014, and more efforts were shown compared to the period from 2005 to 2013. Developed countries such as Japan, China, the USA, Korea, France, Italy, the UK, Netherlands, Turkey, and Brazil played a significant role in publications, contributing to 82.29% of the publications. Our study provides profound insights into sarcopenia's research history, current status, and cancer-related publications, which may indicate its future trend. The countries and collaboration analysis were imbalanced, and there needed better interaction between developing and developed countries or regions, institutions and authors. Therefore, it is vital to strengthen international academic collaboration regarding global sarcopenia and cancer-related publication.
Availability of data and materials
All data generated or analysed during this study are included in this published article.
Web of science
United States of America
Protein-calorie malnutrition (PCM)
Tumour necrosis factor alpha
Science citation index expanded
Single-country publication collaboration
Top impact factor
National cancer institute
National Natural Science Foundation of China
National institute on aging
Total link strength
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Great appreciation to Dr Taha Hussien for his bio-statistical analysis. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript. All authors have contributed sufficiently to the manuscript and approved the final manuscript. This work has not been published previously, nor is any part of its content currently under consideration for publication elsewhere; it will not be published elsewhere in the same form in English or any other language.
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Mohammed, M., Li, J. Knowledge mapping and visualization of current sarcopenia and cancer research: a bibliometric analysis. Beni-Suef Univ J Basic Appl Sci 12, 51 (2023). https://doi.org/10.1186/s43088-023-00386-5