Abstract
ObjectivesSarcopenia is known as a geriatric syndrome associated with increased disability and decreased survival in elderly patients. In oncological patients, pretreatment low skeletal muscle mass (SMM), sometimes referred to as sarcopenia, is an emerging negative prognostic factor. Commonly, only SMM is assessed in cancer patients. Sarcopenia is defined as the combination of low SMM and low muscle function (MF). We investigated the relation between SMM, MF, sarcopenia (SMM and MF combined), and overall survival (OS) in a group of elderly patients with head-and-neck squamous cell carcinoma (HNSCC).Patients and methodsA retrospective study in elderly HNSCC patients treated between 2015 and 2018 was performed. The prognostic value of SMM and MF seperately, and sarcopenia was investigated.ResultsEighty-five patients were included of whom 48.2% had sarcopenia. The median OS was significantly worse for patients treated with curative intent with sarcopenia (12.07 months; IQR 3.64–21.82) compared to patients without sarcopenia (13.60 months; IQR 5.98-27.00) (HR 2.80; 95% CI 1.14–6.88; p = 0.03). SMM and MF seperately were not significant predictors of OS.ConclusionSarcopenia is associated with impaired OS in elderly HNSCC patients. Sarcopenia, defined as the combination of low SMM and low MF, appears to be a better predictor of OS than low SMM or low MF separately.
Highlights
Research into the field of body composition and low skeletal muscle mass (SMM), sometimes referred to as sarcopenia, has increasingly gained interest over the last decade in the field of oncology
Factors with known or suspected relation with head-and-neck squamous cell carcinoma (HNSCC) treatment outcomes and with sarcopenia were collected: age, sex, body mass index (BMI), weight loss in the past 6 months, risk of malnutrition assessed with the malnutrition universal screening tool (MUST), smoking status, alcohol use, comorbidity expressed as a Charlson Comorbidity Index (CCI) score, tumor type, tumor site, human papillomavirus (HPV) status, tumor-node-metastasis (TNM) stage, hematological and biochemical markers at diagnosis, including hemoglobin (Hb), leukocytes, C-reactive protein (CRP), creatinine and albumin, and treatment intention
Literature showed that sarcopenia is associated with several negative outcomes; literature mainly focuses on radiologically assessed low SMM rather than the combination of SMM and muscle function (MF) [6,7,8,9,10,11,12,13,14,15,16]
Summary
Research into the field of body composition and low skeletal muscle mass (SMM), sometimes referred to as sarcopenia, has increasingly gained interest over the last decade in the field of oncology. Sarcopenia is known as an age-related syndrome with a multifactorial etiology, characterized by generalized loss of SMM and loss of muscle strength [1]. Risk factors for the presence of sarcopenia are malnutrition, immobilization, and illness. Independent of age, sarcopenia is impaired in various diseases due to inflammation, malnutrition, and immobilization. Cachexia is a complex metabolic syndrome in which inflammation is the key feature and weight loss (≥ 5% of body weight during the past 12 months) is the key diagnostic criterium. Cachexia can be an underlying condition in patients with sarcopenia [3]
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