The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review

Edwards, A. S.; Brown, Teresa; Hughes, Brett; Bauer, Judy

doi:10.1007/s00520-022-07056-9

Cited by 3 publications

References 69 publications

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Prevalence and Impact of Computed Tomography–Defined Sarcopenia on Survival in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer: A Systematic Review

Edwards

Hughes

Brown

et al. 2022

Advances in Nutrition

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Sarcopenia is a known independent prognostic factor for decreased survival in patients with head and neck cancer, yet its importance for the growing number of younger patients diagnosed with human papillomavirus (HPV) positive oropharyngeal carcinoma (OPC+) has not been established. This systematic literature review aimed to determine the prevalence and impact of computed tomography (CT)-defined sarcopenia on survival outcomes for adult patients (>18 years) with OPC+ undergoing any treatment modality. Prospective studies were searched for using PubMed, Embase, CENTRAL, CINAHL and Web of Science up until and including February 2022. Bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In total, nine studies (total pooled patients with OPC+ n=744) were identified and included in this review; two at low, six at moderate, and one at high risk of bias. All studies varied in sarcopenia assessment methods and skeletal muscle index threshold cut-off values. These studies demonstrated the cumulative prevalence of sarcopenia for patients with OPC+ to be 42.9% (95%CI: 37.8-47.9). While overall survival (three studies, n=253) and progression-free survival (one study, n=117) was lower in sarcopenic patients with OPC+, this was not statistically significant. GRADE certainty of evidence for impact of pre-treatment sarcopenia on overall survival was low and progression-free survival very low. Although these studies showed there to be a high prevalence of pre-treatment sarcopenia in patients with OPC+, which may decrease survival, the impact on progression-free survival is very uncertain. Further, high quality research utilizing consistent sarcopenia definitions and assessment methods that are conducted specifically in OPC+ is required to strengthen evidence certainty and determine if sarcopenia is an independent prognostic factor for this population.

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Prevalence and Impact of Computed Tomography–Defined Sarcopenia on Survival in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer: A Systematic Review

Edwards

Hughes

Brown

et al. 2022

Advances in Nutrition

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Nutritional characterization of patients with oropharyngeal cancers: Impact of human papillomavirus status

Baracos,

Choulli,

Kubrak

et al. 2024

Preprint

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Background Oropharyngeal squamous cell carcinoma (OPSCC) of human papillomavirus (HPV)-positive status is increasing relative to HPV-negative disease. Nutritional features of OPSCC patients according to HPV status is unclear. Subjects/Methods: Canadian and Spanish patients with OPSCC were assessed for body mass index (BMI), weight loss grade (WLG), and computed tomography-defined skeletal muscle index (SMI). Chi-square, t-test, Mann-Whitney-U, Kruskal-Wallis tests were conducted to compare HPV positive and negative groups. Overall survival (OS) was assessed by univariable Kaplan-Meier and Cox proportional hazard methods. Results No differences in BMI, WLG, SMI and adipose tissue index between the 308 (Canada) and 134 (Spain) patients according to HPV status; hence cohorts were pooled (n = 442). HPV-positive patients (n = 317) were overweight/obese (72.8%), had WLG of 0/1 (59.6%) and high SMI (83.4%) while HPV-negative patients were normal/underweight (61.5%), had high WLG 3/4 (50.8%), and moderate/severe SMI depletion (46.9%)(p < 0.003). These overall differences notwithstanding, there was crossover i.e. 35% of HPV-positive patients had high WLG and/or moderate/severe muscle depletion and 29% of HPV-negative patients had minimal weight loss and high SMI. HPV-negative patients had a higher risk of mortality (HR 3.78, 95% CI 2.70 to 5.29, P < 0.001) and this difference was retained after multivariable adjustment for WLG, SMI, age, and disease stage (HR 3.19, 95% CI 2.12 to 4.79, P < 0.001). Conclusion Nutrition features of patients with OPSCC did not differ between Canada and Spain. Distinctive nutrition features exist in patients according to HPV status. The high heterogeneity of individual nutritional profiles invites an individualized approach to nutrition care.

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Prognostic Impact of Sarcopenia’s Occurrence during Radiotherapy in Oropharyngeal Cancer Patients

Bergamaschi

Marvaso

Zaffaroni

et al. 2023

Cancers

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The current study aims to profile sarcopenic condition (both at baseline and developed during treatment) in oropharyngeal carcinoma (OPC) patients treated with curative radiotherapy (RT) +/− chemotherapy and to evaluate its impact on oncological outcomes and toxicity. A total of 116 patients were included in this retrospective single-center study. Sarcopenia assessment at baseline and at 50 Gy re-evaluation CT was obtained from two different methodologies: (i) the L3-skeletal muscle index (SMI) derived from the contouring of the cross-sectional area (CSA) of the masticatory muscles (CSA-MM); and (ii) the paravertebral and sternocleidomastoid muscles at the level of the third cervical vertebra (CSA-C3). Based on L3-SMI from CSA-MM, developing sarcopenic condition during RT (on-RT sarcopenia) was associated with worse progression-free survival (PFS) (p = 0.03) on multivariable analysis and a trend of correlation with overall survival (OS) was also evident (p = 0.05). According to L3-SMI derived from CSA-C3, on-RT sarcopenia was associated with worse PFS (p = 0.0096) and OS (p = 0.013) on univariate analysis; these associations were not confirmed on multivariable analysis. A significant association was reported between becoming on-RT sarcopenia and low baseline haemoglobin (p = 0.03) and the activation of nutritional counselling (p = 0.02). No significant associations were found between sarcopenia and worse RT toxicity. Our data suggest that the implementation of prompt nutritional support to prevent the onset of sarcopenia during RT could improve oncological outcomes in OPC setting.

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The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review

Cited by 3 publications

References 69 publications

Prevalence and Impact of Computed Tomography–Defined Sarcopenia on Survival in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer: A Systematic Review

Prevalence and Impact of Computed Tomography–Defined Sarcopenia on Survival in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer: A Systematic Review

Nutritional characterization of patients with oropharyngeal cancers: Impact of human papillomavirus status

Prognostic Impact of Sarcopenia’s Occurrence during Radiotherapy in Oropharyngeal Cancer Patients

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