Association of Sarcopenia With Oncologic Outcomes of Primary Surgery or Definitive Radiotherapy Among Patients With Localized Oropharyngeal Squamous Cell Carcinoma

Abstract

The negative association of low lean muscle mass (sarcopenia) with survival outcomes in head and neck cancers, including oropharyngeal carcinoma, is established. However, it is not known whether the choice of primary treatment modality (surgery or radiotherapy) is associated with oncologic outcomes of patients with sarcopenia and oropharyngeal squamous cell carcinoma (OPSCC).OBJECTIVE To examine whether primary surgical resection or definitive radiotherapy is associated with improved survival for patients with sarcopenia and localized OPSCC. DESIGN, SETTING, AND PARTICIPANTSA cohort study was conducted of patients with clinically staged T1 to T2, N0 to N2 OPSCC with cross-sectional abdominal imaging within 60 days prior to treatment and treated between January 1, 2005, and December 31, 2017. Skeletal muscle mass was measured at the third lumbar vertebra using previously defined techniques and sarcopenia was defined as less than 52.4 cm 2 /m 2 of muscle for men and less than 38.5 cm 2 /m 2 for women. In addition, associated patient demographic characteristics, cancer data, treatment information, and survival outcomes were assessed. Statistical analysis was performed from December 3, 2018, to August 28, 2019.MAIN OUTCOMES AND MEASURES Primary outcomes were overall survival and disease-specific survival. RESULTS Among the 245 patients who met study inclusion criteria, 209 were men (85.3%) and the mean (SD) age was 62.3 (7.8) years. Sarcopenia was detected in 135 patients (55.1%), while normal skeletal muscle mass was detected in 110 patients (44.9%). For the 110 patients without sarcopenia, primary treatment modality was not associated with improved survival. For patients with sarcopenia at diagnosis, primary surgical resection was associated with improved overall survival (hazard ratio [HR], 0.37; 95% CI, 0.17-0.82) and disease-specific survival (HR, 0.22; 95% CI, 0.07-0.68). This association persisted after propensity score matching, as up-front surgery was associated with improved overall survival (HR, 0.33; 95% CI, 0.12-0.91) and disease-specific survival (HR, 0.17; 95% CI, 0.04-0.75) survival. CONCLUSIONS AND RELEVANCEThis study suggests that sarcopenia has a negative association with survival for patients with OPSCC. Primary surgery and radiotherapy confer similar survival associations for patients with normal skeletal muscle mass and localized OPSCC. However, up-front surgical resection may be associated with improved survival outcomes for patients with sarcopenia.

Low skeletal muscle mass predicts relevant clinical outcomes in head and neck squamous cell carcinoma. A meta analysis

“…The included 27 articles provided information regarding prevalence of sarcopenia and/or the influence of sarcopenia on complications and survival in patients with HNSCC. 13 – 39 …”

Temporal Muscle Thickness is an Independent Prognostic Biomarker in Patients with Glioma: Analysis of 261 Cases

“…It has been documented that loss of skeletal muscle or sarcopenia is associated with the clinical prognosis of numerous cancers. 16,20,21 It is not feasible for glioma patients to measure lumbar skeletal muscle using abdominal CT for assessing skeletal muscle mass during diagnosis. However, Leitner et al 17 considered that TMT, readily acquired on brain MR images, was related to the lumbar skeletal muscle dimension and was a helpful replacement parameter for the appraisal of skeletal muscle mass in patients with brain metastases.…”

Association of Sarcopenia With Toxicity and Survival in Postoperative Recurrent Esophageal Squamous Cell Carcinoma Patients Receiving Chemoradiotherapy

“…Sarcopenia has been correlated with shorter survival in certain solid cancers such as oropharyngeal squamous cell carcinoma, non-small cell lung cancer, and nasopharyngeal carcinoma (30)(31)(32). Currently, to our knowledge, 6 studies investigated the effect of sarcopenia on survival in EC patients who received surgical resection (9,18,(33)(34)(35)(36).…”

“…From January 2016, patients aged older than 70 years were treated with S-1 (70 mg/m 2 , twice per day, on days 1-14 and days [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] based concurrent chemotherapy to avoid the severe adverse events. In these patients, adjuvant chemotherapy with S-1 (70 mg/m 2 , on days 1-21 every 4 weeks) was done after radiotherapy if possible.…”