Abstract
PurposeSarcopenia, defined as a loss of muscle mass and quality, has been associated with impaired oncological outcome and treatment toxicities in several malignancies. However, its role in anal squamous cell carcinoma (ASCC) remains less well explored.Methods/MaterialsPlanning CT scans were used to measure cross-sectional skeletal muscle area (SMA) to calculate the skeletal muscle index (SMI). The association of sarcopenia with clinical and treatment-related parameters, and toxicity was assessed in 114 patients with ASCC that underwent standard 5-Fluorouracil/Mitomycin C chemoradiotherapy (CRT). The prognostic impact of sarcopenia on local relapse-free survival (LRFS), disease-free survival (DFS), and overall survival was examined using a Cox regression analysis.Results29 (25.4%) patients had sarcopenia. Patients with sarcopenia had lower baseline hemoglobin levels (p = 0.002), worse Karnofsky Performance Status (p = 0.001) lower BMI (p < 0.001), and a significantly lower body surface area (p = 0.03), and lower incidence of involved lymph nodes (p = 0.03). Regarding acute toxicity, sarcopenia was associated with a significantly higher incidence of ≥grade 3leukopenia (OR: 3.5; 95% CI: 1.6–7.5, p = 0.007) and ≥grade 3 thrombopenia (OR: 5.1; 95% CI: 1.3–21, p = 0.018) after CRT. Despite higher hematologic toxicity in sarcopenic patients, total treatment time was similar between patients with and without sarcopenia (median 44 vs 45 days, p = 0.95). There was no significant prognostic impact of sarcopenia on either LRFS, DFS, or OS.ConclusionThis is the largest study to assess the impact of sarcopenia on toxicity and oncological outcome in patients with ASCC. Increased clinician awareness of higher hematological toxicity risk is needed for sarcopenic patients with ASCC undergoing CRT to facilitate closer monitoring of side effects and earlier introduction of supportive measures. Further prospective studies are needed to elucidate the prognostic role and impact of sarcopenia on CRT-related toxicity in ASCC.
Highlights
Anal squamous cell carcinoma (ASCC) is associated with human papilloma virus (HPV) infection [1]
In the field of oncology, sarcopenia is defined as a loss of muscle quantity measured as a low appendicular skeletal muscle index (SMI), that can be measured by dual energy x ray absorptiometry [6]
After exclusion of patients with missing follow up, missing data, other chemotherapy regimens that 5-fluorouracil (5-FU), and mitomycin C (MMC) or computed tomography (CT) artifacts we identified 114 patients treated for localized ASCC and staged according to UICC version 7
Summary
Anal squamous cell carcinoma (ASCC) is associated with human papilloma virus (HPV) infection [1]. Sarcopenia, defined as loss of muscle quantity and muscle strength, has mainly been recognized as an age-related phenomenon, but is associated with cancer cachexia [6]. In the field of oncology, sarcopenia is defined as a loss of muscle quantity measured as a low appendicular skeletal muscle index (SMI), that can be measured by dual energy x ray absorptiometry [6]. Most widely used are computed tomography (CT) scans of the third lumbar area to measure the skeletal muscle area (SMA) to calculate the SMI by adjusting for height. This measurement correlates closely to the whole body muscle quantity [7]
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