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Sarcopenia predicts a poor treatment outcome in patients with head and neck squamous cell carcinoma receiving concurrent chemoradiotherapy

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Abstract

Purpose

Sarcopenia, defined as a decrease in the skeletal muscle mass and its function, is associated with a poor clinical outcome in several malignancies. We aimed to examine whether sarcopenia can be a predictor of incompletion of concurrent chemoradiotherapy (CCRT) and survival for head and neck cancer (HNC) patients.

Methods

Forty-one male HNC patients who received CCRT were enrolled in the study. Cross-sectional muscle areas at the third lumbar vertebral level were normalized by the squared height of the patients and were termed the lumbar skeletal muscle index (LSMI, cm2/m2), a marker of sarcopenia. Patients were divided into high (30/41, 73%) and low (11/41, 27%) LSMI groups. The LSMI cut-off value was set at 39.7 cm2/m2 based on a receiver operating characteristic curve for incompletion of CCRT. The groups were compared for survival rate by the Kaplan–Meier method. Factors predicting incompletion of CCRT were investigated among several variables.

Results

Multivariate analysis showed that a pre-treatment low LSMI (P = 0.033) and age over 70 years (P = 0.023) were the only significant predictors for incompletion of CCRT. The 2-year disease-specific survival (DSS) rate was significantly lower in the low LSMI group (61%) than in the high LSMI group (97%, P = 0.012), whereas there were no differences in the DSS rate between the low and high body mass index groups.

Conclusion

The prevalence of sarcopenia in HNC patients receiving CCRT was 27%. Its presence before treatment was a significant predictor of incomplete CCRT and poor DSS rate in HNC patients.

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Funding

This work was supported by an operating fund of the Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences. We have not received any funding from other organizations.

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Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahi-machi, Chuo-ku, Niigata, 951-8510, Japan

    Ryusuke Shodo, Keisuke Yamazaki, Yushi Ueki, Takeshi Takahashi & Arata Horii

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  1. Ryusuke Shodo
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  2. Keisuke Yamazaki
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  3. Yushi Ueki
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  4. Takeshi Takahashi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by RS, TT, YU, and KY. The first draft of the manuscript was written by RS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ryusuke Shodo.

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The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of Niigata University Hospital (identification No. 2018-0250). and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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These data were presented at the 2019 American Head and Neck Society (AHNS) meeting on May 2, 2019, in Austin, Texas.

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Shodo, R., Yamazaki, K., Ueki, Y. et al. Sarcopenia predicts a poor treatment outcome in patients with head and neck squamous cell carcinoma receiving concurrent chemoradiotherapy. Eur Arch Otorhinolaryngol 278, 2001–2009 (2021). https://doi.org/10.1007/s00405-020-06273-4

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  • DOI: https://doi.org/10.1007/s00405-020-06273-4

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