Sarcopenia Significantly Associated with Poorer Overall Survival of Patients with Head and Neck Cancers

Is radiologically defined sarcopenia at the C3 or L3 level prognostic of overall survival (OS) in head and neck cancers (HNCs)?

BOTTOM LINE: Pretreatment sarcopenia as radiologically defined by decreased skeletal muscle index (SMI) or skeletal muscle mass (SMM) correlates with poor survival in HNC patients.

BACKGROUND: Research findings associate sarcopenia, defined via computed tomography (CT) or magnetic resonance imaging (MRI), with negative outcomes in patients with head and neck squamous cell carcinoma (HNSCC). However, no higher evidence is available specifically to assess the prognostication of HNC using radiologically defined sarcopenia.

STUDY DESIGN: Literature review and meta-analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, N.Y.

SYNOPSIS: To examine the relationship between radiologically defined sarcopenia and OS in HNCs, the researcher used 10 studies (nine retrospective, one prospective) published between 2016 and 2019, each ranging from 85 to 441 patients. Although each study reported on HNSCC OS in sarcopenic patients, the specific cancer sites in each study varied. All studies used CT, MRI, or both, and all reported OS as an outcome. Eight of the 10 studies found that radiologically defined sarcopenia was significantly associated with worse OS. The authors found no significant heterogeneity between studies. The majority of studies used L3 SMI to determine the cutoffs for sarcopenia, although authors found evidence that C3 skeletal mass measurement could be a reliable measurement tool as well. Pooled data showed that sarcopenia was significantly associated with poorer OS of patients with HNCs. Although the exact pathogenesis of sarcopenia is unknown and there remains no universal diagnostic definition of sarcopenia, authors conclude that radiologically defined sarcopenia might be a useful tool to identify patients who might benefit from adjuvant or additional therapies. Study limitations included variation of cancer sites and sarcopenia definition criteria.

CITATION: Wong A, Zhu D, Kraus D, Tham T. Radiologically defined sarcopenia affects survival in head and neck cancer: a meta-analysis [published online ahead of print March 27, 2020]. Laryngoscope. doi:10.1002/lary.28616.