Impact of sarcopenia and myosteatosis on survival outcomes for patients with head and neck cancer undergoing curative-intent treatment.

Elizabeth Ahern,Judith D Bauer,Lizbeth M Kenny,Brett G M Hughes,Merrilyn D Banks,Louise Campbell,Charles Y Lin,Teresa E Brown

doi:10.1017/s0007114522000435

Abstract

Malnutrition and sarcopenia are prevalent in patients with head and neck squamous cell carcinoma (HNSCC). Pre-treatment sarcopenia and adverse oncological outcomes in this population are well described. The impact of myosteatosis and post-treatment sarcopenia is less well known. Patients with HNSCC (n = 125) undergoing chemoradiotherapy, radiotherapy alone and/or surgery were assessed for sarcopenia and myosteatosis, using cross-sectional computed tomography (CT) imaging at the third lumbar (L3) vertebra, at baseline and 3 months post-treatment. Outcomes were overall survival (OS) at 12 months and 5 years post-treatment. One hundred and one participants had a CT scan evaluable at one or two time points, of which sixty-seven (66 %) participants were sarcopenic on at least one time point. Reduced muscle attenuation affected 93 % (n = 92) pre-treatment compared with 97 % (n = 90) post-treatment. Five-year OS favoured those without post-treatment sarcopenia (hazard ratio, HR 0·37, 95 % CI 0·16, 0·88, P = 0·06) and those without both post-treatment myosteatosis and sarcopenia (HR 0·33, 95 % CI 0·13, 0·83, P = 0·06). Overall, rates of myosteatosis were high at both pre- and post-treatment time points. Post-treatment sarcopenia was associated with worse 5-year OS, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be evaluated as an independent risk factor for decreased long-term survival post-treatment containing radiotherapy (RT) for HNSCC.

Highlights

Malnutrition is prevalent in up to 50% patients with head and neck squamous cell cancer (HNSCC), owing to tumour factors and treatment factors reducing oral intake[1,2]
Eligible patients were identified through the head and neck multidisciplinary clinic as those treated with curative intent for HNSCC who were referred by the treating team for prophylactic gastrostomy
Of the initial 131 participants reported in the previous study, 6 subsequently withdrew consent and have been excluded, leaving 125 participants assessed for outcomes in this study

Summary

Introduction

Malnutrition is prevalent in up to 50% patients with head and neck squamous cell cancer (HNSCC), owing to tumour factors (such as anatomic location and metabolic requirements) and treatment factors (such as acute and chronic toxicities of radiotherapy, chemotherapy or surgery) reducing oral intake[1,2]. Malnutrition associated with cancer comprises loss of skeletal muscle with or without loss of adipose tissue, associated with weight loss[3,4]. Sarcopenia is a term with heterogenous definitions and applications, but which expert consensus has defined as a combination of skeletal muscle depletion combined with functional impairment[5]. A related but distinct entity associated with cancer is myosteatosis, which relates to intramuscular adipose infiltration, detected on cross-sectional imaging as a reduction in muscle tissue density[6]. Both sarcopenia and myosteatosis have been associated with adverse outcomes in various cancers, including excess mortality[6,7,8]. A frequent method comprises assessment of a cross-sectional area on computed tomography (CT) scan (or the CT component of positron emission tomography (PET) scan) at the level of the third lumbar vertebra (L3) where a reference sex-specific lower limit of normal skeletal muscle index (SMI) is applied[10,11,12,13,14]

Methods

Results

Conclusion