The prognostic value of pre-treatment sarcopenia in overall survival in head and neck cancer patients: a systematic review

Abstract

The aim of this study was to determine the prognostic value of pre-treatment sarcopenia, defined radiologically (cervical (C3) or lumbar (L3) region), in adult head and neck cancer (HNC) patients undergoing treatment with curative intent. A systematic search of the PubMed and Scopus databases was performed up to March 2024. Inclusion criteria were adult patients with locally advanced HNC, sarcopenia defined radiologically at the C3 and/or L3 level, and patients receiving primary treatment with curative intent. Risk of bias was assessed using the ROBINS-I tool for non-randomised studies. Thirty studies (25 retrospective, five prospective) involving a total of 6924 adult patients with HNC were included in this review. Pre-treatment sarcopenia was significantly associated with worse overall survival outcomes in 26 of the 30 studies (87%), across all treatment modalities with curative intent. Various skeletal muscle index (SMI) cut-off values for sarcopenia were applied. The sex-specific SMI cut-off values of <52.4 cm2/m2 for males and <38.5 cm2/m2 for females were the most frequently used (eight studies); these studies all reported a significant association between sarcopenia and worse overall survival. Despite the majority of included studies being retrospective and the inconsistency in SMI cut-off values, the findings of this review suggest that sarcopenia is a strong prognostic factor of overall survival in HNC patients undergoing primary curative treatment. Regarding the clinical implications of these findings, sarcopenia evaluation appears to be a good prognostic marker in the HNC population. Future nutritional interventional studies might focus on reversing the muscle loss and improving overall outcomes in identified sarcopenic individuals.