Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur J Cancer. 2019 Jul;116:98-106. doi: 10.1016/j.ejca.2019.05.006. Epub 2019 Jun 10.
Head and neck squamous cell carcinoma (HNSCC) is commonly associated with a high risk of malnutrition and sarcopenia, related to adverse clinical outcomes. This study evaluated the prognostic values of body composition on recurrence and survival in patients with advanced-stage HNSCC.
This study prospectively enrolled 258 consecutive patients with definitive treatments for advanced-stage HNSCC. For the determination of sarcopenia, the cross-sectional area of the skeletal muscles (SMs) was measured at the level of the third lumbar vertebra on the computed tomography images of whole-body F-fluorodeoxyglucose positron-emission tomography/computed tomography before and after treatments. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the prognostic factors of disease-free survival (DFS) and overall survival (OS).
Pretreatment and post-treatment diminished SM masses (sarcopenia) were found in 17 (6.6%) and 32 (12.4%) of 258 included patients, respectively. All values of body composition, SM index, visceral fat area, lean body mass, fat mass and body mass index significantly decreased after treatment (all P < 0.05). Multivariable analyses showed that age, Charlson comorbidity index, pretreatment and post-treatment sarcopenia, pretreatment hypoalbuminaemia, p16 status and tumour site remained the independent variables predictive of DFS and OS outcomes (all P < 0.05). Patients with sarcopenia before or after treatment had about threefold increased risk of overall recurrence or death.
Diminished SM mass may predict recurrence and survival after definitive treatments in patients with advanced-stage HNSCC.
头颈部鳞状细胞癌（HNSCC）常伴有营养不良和肌肉减少症的高风险，与不良临床结局相关。本研究评估了身体成分对晚期 HNSCC 患者复发和生存的预后价值。
本研究前瞻性纳入 258 例接受晚期 HNSCC 确定性治疗的连续患者。为了确定肌肉减少症，在治疗前后的全身 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描的全身图像上测量第三腰椎水平的骨骼肌（SM）横截面积。进行单变量和多变量 Cox 比例风险回归分析，以确定无病生存（DFS）和总生存（OS）的预后因素。
在 258 例纳入的患者中，分别有 17 例（6.6%）和 32 例（12.4%）在治疗前和治疗后发现 SM 质量（肌肉减少症）减少。所有身体成分、SM 指数、内脏脂肪面积、瘦体重、脂肪量和体重指数在治疗后均显著下降（均 P<0.05）。多变量分析表明，年龄、Charlson 合并症指数、治疗前和治疗后肌肉减少症、治疗前低白蛋白血症、p16 状态和肿瘤部位仍然是预测 DFS 和 OS 结局的独立变量（均 P<0.05）。治疗前或治疗后有肌肉减少症的患者总复发或死亡的风险增加约三倍。
SM 质量减少可能预测晚期 HNSCC 患者确定性治疗后的复发和生存。
