Sarcopenia may predict recurrence in patients with head and neck cancer

Background: Malnutrition is a major consequence of head and neck cancer (HNC), often leading to decreased skeletal muscle mass and impacting survival. The goal of this study is to determine the effect of sarcopenia, as defined by skeletal muscle index (SMI), on survival in patients with HNC.

Methods: This is a retrospective review of patients with HNC treated with surgery and/or radiation at a single tertiary care institute. All had pre-treatment imaging available for skeletal muscle index (SMI) measurements, and SMI was calculated at the level of the 3rd cervical vertebra. Sarcopenia was defined as an SMI < 41 cm²/m² in females and as <43 cm²/m² in underweight or healthy weight males. Sarcopenia was defined as <53 cm²/m² in overweight or obese males. Chi-square analysis was performed to compare recurrence and survival rates, and survival analysis was performed via Kaplan-Meir curve.

Results: Hundred and twelve patients with HNC were evaluated, 84 men and 28 women with an average age of 60.9 years. Tumors were primarily located in the oral cavity (24.1%) and oropharynx (42%). The majority (69.6%) underwent surgery. Mean body mass index prior to treatment was 28. Sixty-nine patients (61.6%) in our cohort had low SMI. Mean follow-up was 3.9 ± 2.2 years. Recurrence rate was 26% in those with low SMI versus 2% in those without. Patients with low SMI were more likely to have a recurrence (p = 0.02). Overall survival was 72.5% in those with low SMI and 81% in those with normal SMI (p = 0.09).

Conclusions: Defining sarcopenia as a low skeletal muscle index at the third cervical vertebra is clinically relevant. This study demonstrates that low SMI at this level, and thus sarcopenia, was strongly associated with higher rates of recurrence.