Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands.
Radiother Oncol. 2020 Jun;147:103-110. doi: 10.1016/j.radonc.2020.03.014. Epub 2020 Apr 3.
Sarcopenia is emerging as an adverse prognostic factor for survival and complication risk in cancer patients. This study aims to determine the impact of sarcopenia on survival and late toxicity in a large cohort of head and neck squamous cell carcinoma (HNSCC) patients treated with definitive (chemo)radiotherapy ((C)RT).
HNSCC patients treated with definitive (C)RT from January 2007 to June 2016 were included. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscles at level C3. The impact of sarcopenia on overall survival (OS) and disease-free survival (DFS) was evaluated using the Kaplan-Meier method. Multivariable association models were developed to assess the impact of sarcopenia on late toxicity.
The study population was composed of 750 HNSCC patients. Cut-off values for sarcopenia were set at SMI < 42.4 cm/m (men) and <30.6 cm/m (women) corresponding lowest gender specific quartile. Sarcopenic patients had significantly poorer survival rates, especially those with lower performance status and locally advanced disease. In oropharyngeal cancer patients, survival was more determined by p16 status than by sarcopenia. In multivariable analysis, sarcopenia was associated with worse OS (HR 0.72, p = 0.012) and DFS (HR 0.67, p = 0.001). In multivariable association models, sarcopenia was associated with physician-rated xerostomia six months after treatment (OR 1.65, p = 0.027) and physician-rated dysphagia six and twelve months after treatment (OR 2.02, p = 0.012 and 2.51, p = 0.003, respectively).
Sarcopenia in HNSCC patients receiving definitive (C)RT is an independent prognostic factor for worse survival outcomes and is associated with physician-rated toxicity.
肌肉减少症已成为癌症患者生存和并发症风险的不良预后因素。本研究旨在确定在接受根治性（放化疗）（C）RT 的大型头颈部鳞状细胞癌（HNSCC）患者队列中，肌肉减少症对生存和晚期毒性的影响。
纳入 2007 年 1 月至 2016 年 6 月期间接受根治性（C）RT 的 HNSCC 患者。使用 C3 水平的骨骼肌评估放射治疗计划 CT 扫描中的肌肉减少症。使用 Kaplan-Meier 方法评估肌肉减少症对总生存期（OS）和无病生存期（DFS）的影响。建立多变量关联模型以评估肌肉减少症对晚期毒性的影响。
研究人群由 750 例 HNSCC 患者组成。肌肉减少症的截断值设定为 SMI<42.4cm/m（男性）和<30.6cm/m（女性），分别对应最低性别特定四分位数。肌肉减少症患者的生存率明显较低，尤其是那些体能状态较低和局部晚期疾病的患者。在口咽癌患者中，生存更多地由 p16 状态决定，而不是肌肉减少症。多变量分析显示，肌肉减少症与较差的 OS（HR 0.72，p=0.012）和 DFS（HR 0.67，p=0.001）相关。在多变量关联模型中，肌肉减少症与治疗后六个月医生评估的口干症（OR 1.65，p=0.027）以及治疗后六个月和十二个月医生评估的吞咽困难（OR 2.02，p=0.012 和 2.51，p=0.003）相关。
接受根治性（C）RT 的 HNSCC 患者的肌肉减少症是生存结果较差的独立预后因素，并且与医生评估的毒性相关。
