Establishment and Validation of Pre-Therapy Cervical Vertebrae Muscle Quantification as a Prognostic Marker of Sarcopenia in Patients With Head and Neck Cancer

Abstract

BackgroundSarcopenia is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging without computed tomography (CT) imaging of the abdomen or thorax. Herein, we establish sarcopenia thresholds at the C3 level and determine if C3 sarcopenia is associated with survival in patients with HNC.MethodsThis retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment. Measurement of cross-sectional muscle area at L3 and C3 levels was performed from CT imaging. Primary study outcome was overall survival.ResultsSkeletal muscle area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3 sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of L3 sarcopenia thresholds. Applying these C3 thresholds to a cohort of patients with neck imaging alone revealed that C3 sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85).ConclusionsThis study identifies sarcopenia thresholds at the C3 level that best predict L3 sarcopenia in men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

Deep learning auto-segmentation of cervical skeletal muscle for sarcopenia analysis in patients with head and neck cancer

“…These results are consistent with recent literature by Olson et al. ( 16 ) which emphasized that sarcopenia was associated with poor survival outcomes in males but not in females. Our results suggest that our automated methods are dependable for use in prognostic outcome prediction.…”

“…However, abdominal imaging is not available for all HNC patients. Importantly, Swartz et al (15), van Rijn-Dekker et al (6), and Olson et al (16) have recently suggested the C3 cervical vertebra musculature cross-sectional area may also be used to quantify sarcopenia accurately.…”

“…( 6 ), and Olson et al. ( 16 ) have recently suggested the C3 cervical vertebra musculature cross-sectional area may also be used to quantify sarcopenia accurately.…”

Muscle and adipose tissue segmentations at the third cervical vertebral level in patients with head and neck cancer

“…The segmentations provided in this data descriptor have been utilized as ground-truth segmentations in a previous study by Naser et al . 12 which yielded sarcopenia determination results (normal vs. depleted skeletal muscle) that were consistent with existing literature 9 , i.e., overall survival stratification is significant in males but not females as determined by Kaplan Meier analysis. Note: 4 patients included in the current data descriptor were excluded from the aforementioned analysis (TCIA ID’s: 0226, 0280, 0577, and 0607), due to oblique image orientation mask issues previously described in Methods.…”

“…Moreover, to date, there are no existing open-source repositories for body composition analysis data based on head and neck region imaging. Increasing evidence has shown the potential utility of sarcopenia determination using skeletal muscle in the head and neck region 2 , 9 . This is driven by the fact that many patients with HNC may not have abdominal imaging acquired as part of the standard workup, but will almost certainly have head and neck region imaging acquired, particularly due to its necessity for radiotherapy treatment planning 10 and staging purposes 11 .…”