Skeletal Muscle Depletion and Major Postoperative Complications in Locally-Advanced Head and Neck Cancer: A Comparison between Ultrasound of Rectus Femoris Muscle and Neck Cross-Sectional Imaging

Abstract

Skeletal muscle mass (SMM) depletion has been validated in many surgical fields as independent predictor of complications through cross-sectional imaging. We evaluated SMM depletion in a stage III-IV head and neck cancer cohort, comparing the accuracy of CT/MRI at C3 level with ultrasound (US) of rectus femoris muscle (RF) in terms of prediction of major complications. Patients submitted to surgery were recruited from 2016 to 2021. SMM was estimated on CT/MRI by calculating the sum of the cross-sectional area (CSA) of the sternocleidomastoid and paravertebral muscles at C3 level and its height-indexed value (cervical skeletal muscle index, CSMI) and on US by computing the CSA of RF. Specific thresholds were defined for both US and CT/MRI according to ROC curve in terms of best prediction of 30-day major complications to detect sarcopenic subjects (40–53%). Sixty-five patients completed the study. At univariate analysis, major complications were associated to lower RF CSA, lower CSA at C3 level and lower CSMI, together with previous radiotherapy, higher ASA score and higher modified frailty index (mFI). At multivariate analysis RF CSA (OR 7.07, p = 0.004), CSA at C3 level (OR 6.74, p = 0.005) and CSMI (OR 4.02, p = 0.025) were confirmed as independent predictors in three different models including radiotherapy, ASA score and mFI. This analysis proved the value of SMM depletion as predictor of major complications in a head and neck cancer cohort, either defined on cross-sectional imaging at C3 or on US of RF.

Impact of low skeletal muscle mass in oropharyngeal cancer patients treated with radical chemo-radiotherapy: A mono-institutional experience

“…According to the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), 8 sarcopenia is a condition characterized by low muscle strength, low muscle quantity or quality and low physical performance. Sarcopenia is both a nutrition disorder and a nutrition related condition 1 and seems to be associated with a worse prognosis, 9 , 10 lower tolerance to the treatments 11 – 13 and enhanced inflammatory status. 14 – 16 It does not simply reflect the physical condition, but also acts as an endocrine organ that secretes several specific cytokines also called myokine, able to influence tissue metabolism and organ inflammatory status.…”

Selected Body Composition Parameters Analysis Based on Bioelectrical Impedance in Patients Operated for Gastrointestinal Cancer

“…A meta-analysis of studies describing overall survival after gastrectomy showed a worse prognosis in patients with reduced FFM (32). Similarly, in CT studies, it was found that a decrease in mass and deterioration in skeletal muscle function were associated with postoperative complications, prolonged hospital stay and a worse prognosis (33)(34)(35)(36)(37)(38)(39)(40)(41)(42).…”

Thoracic skeletal muscle index is effective for CT-defined sarcopenia evaluation in patients with head and neck cancer

“…Recently, Zwart et al suggested sex-specific low C3-SMI values for risk of radiotherapy toxicities in a similar, yet smaller cohort ( n = 196), applying the ROC curve method; however, all AUC values were poor at < 0.7 [ 36 ]. Similarly, Galli et al applied ROC curves for low cervical SMM cutoff values, again with low AUCs < 0.63 [ 37 ]. The difficulty with establishing universal cutoff values in HNC is the heterogeneity of patients, with differing presentation characteristics for each specific tumour site, and studies investigating different cohorts of tumours of the head and neck (e.g., inclusion of salivary gland or nasal cavity tumours).…”