Evaluation of overall and disease‐free survival in patients with free flaps for oral cancer resection

Abstract

Purpose Sarcopenia is characterized by depletion of skeletal muscle mass (SMM) and can cause increased postoperative complication in free flap procedure. One of the most important considerations while deciding the indication of the procedure is patients' survival. This study aimed to verify the relationship between low SMM and survival in patients who undergo oral cancer resection using free flap. Methods SMM was evaluated using the skeletal muscle index (SMI cm2/m2), which was defined using cross‐sectional areas of skeletal muscles on computed tomography at the level of the third lumbar vertebrae normalized for height. Overall, 111 patients who underwent primary oral cancer resection and free flaps were included. Multivariate Cox regression analyses were used to evaluate the prognostic factors for survival. Results A total of 25 patients (22.5%) were diagnosed with low SMM. The mean SMI was 42.2 cm2/m2. Multivariable analyses showed that increased age (hazard ratio [HR]; 4.98, p = .004), infiltrative growth pattern INF‐c (HR; 3.83, p = .037), and low SMM (HR; 2.59, p = .034) were significant negative prognostic factors for overall survival. Increased age (HR; 3.18, p = .005), extra‐nodal extension (HR; 3.30, p = .001), and low SMM (HR; 2.42, p = .017) were significant negative prognostic factors for disease‐free survival. Conclusions Low SMM is a significant negative prognostic factor for overall and disease‐free survival in oral cancer patients undergoing free flap. Future prospective studies are warranted to identify effective preoperative exercise and nutrition programs to improve low skeletal muscle and survival rate in patients undergoing free flap procedures.

Prognostic impact of sarcopenia in patients with head and neck cancer treated with surgery or radiation: A meta-analysis

“…We screened the titles and abstracts of these studies and identified 83 potentially eligible studies. The full-text versions of these 83 studies were then inspected according to the exclusion criteria, and 18 studies involving 3,233 patients were determined to be eligible for inclusion in this study [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1). In these 18 studies, seven investigated patients treated with surgery [17, 20, 25-27, 31, 32] and 10 investigated patients treated with RT [15, 16, 18, 19, 21-24, 29, 30].…”

“…[31] used the psoas muscle mass index, and the study by Choi et al [21] used the skeletal muscle area of the neck. The remaining 16 studies used skeletal muscle mass index (SMI), with seven [15,18,23,25,[27][28][29] and nine [16,17,19,20,22,24,26,30,32] studies measuring the muscle area at the L3 and C3 spine levels, respectively. Eight studies [16, 18, 19, 22-24, 29, 30] in the RT group and six studies [17,20,[25][26][27]31] in the surgery group reported stage distribution between stage I, II and stage III, IV disease.…”

“…The remaining 16 studies used skeletal muscle mass index (SMI), with seven [15,18,23,25,[27][28][29] and nine [16,17,19,20,22,24,26,30,32] studies measuring the muscle area at the L3 and C3 spine levels, respectively. Eight studies [16, 18, 19, 22-24, 29, 30] in the RT group and six studies [17,20,[25][26][27]31] in the surgery group reported stage distribution between stage I, II and stage III, IV disease. Among them, 79.0% of the 1772 patients in the RT group had stage III, IV disease, whereas 63.4% of the 1026 patients in the surgery group had stage III, IV disease.…”

“…To exclude the effect of confounding factors, we conducted an analysis for adjusted HRs. Twelve studies [15,17,19,21,[23][24][25][26][27][30][31][32] showed…”

“…Other myokines, including IL-15, IL-8, and myostatin, can also affect oncologic outcomes [43]. Fourth, sarcopenia may be associated with a progressive tumor status, with some studies showing advanced T and N classifications in sarcopenic patients [17,27,44]. Finally, sarcopenia increases adverse events during and after RT, including aspiration pneumonitis during CRT [22] and dose-limiting toxicity during cetuximab treatment [24].…”