Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, The Netherlands.
Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, The Netherlands.
Radiother Oncol. 2022 May;170:122-128. doi: 10.1016/j.radonc.2022.03.009. Epub 2022 Mar 15.
Sarcopenia is related to late radiation-induced toxicities and worse survival in head and neck cancer (HNC) patients. This study tested the hypothesis that sarcopenia improves the performance of current normal tissue complication probability (NTCP) models of radiation-induced acute toxicity in HNC patients.
MATERIAL/METHODS: This was a retrospective analysis in a prospective cohort of HNC patients treated from January 2007 to December 2018 with (chemo)radiotherapy. Planning CT scans were used for evaluating skeletal muscle mass. Characteristics of sarcopenic and non-sarcopenic patients were compared. The impact of sarcopenia was analysed by adding sarcopenia to the linear predictors of current NTCP models predicting physician- and patient-rated acute toxicities.
The cut-off values of sarcopenia in the study population (n = 977) were established at skeletal muscle index < 42.0 cm2/m2 (men) and < 31.2 cm2/m2 (women), corresponding to the lowest sex-specific quartile. Compared to non-sarcopenic patients, sarcopenic patients were more frequently smokers (61% vs. 48%, p < 0.001), had more often advanced stage of disease (stage III-IV, p = 0.004), higher age (67 vs. 63 years, p < 0.001) and experienced more pretreatment complaints, such as dysphagia (grade ≥ 2, p < 0.001). Sarcopenia remained statistically significant, next to the linear predictor, only for physician-rated grade ≥ 3 dysphagia (week 3-6 during RT, p < 0.01). However, sarcopenia did not improve the performance of these NTCP models (p > 0.99).
Sarcopenia in HNC patients was an independent prognostic factor for radiation-induced physician-rated acute grade ≥ 3 dysphagia, which might be explained by its impact on swallowing muscles. However, addition of sarcopenia did not improve the NTCP model performance.
肌肉减少症与头颈部癌症（HNC）患者的晚期放射性毒性和生存状况较差有关。本研究检验了这样一个假设，即肌肉减少症可以改善当前用于预测 HNC 患者放射性急性毒性的正常组织并发症概率（NTCP）模型的性能。
材料/方法：这是一项回顾性分析，纳入了 2007 年 1 月至 2018 年 12 月期间接受放化疗的前瞻性 HNC 患者队列研究。计划 CT 扫描用于评估骨骼肌质量。比较了肌肉减少症患者和非肌肉减少症患者的特征。通过将肌肉减少症纳入预测医生和患者急性毒性的当前 NTCP 模型的线性预测因子，分析肌肉减少症的影响。
在研究人群（n=977）中，肌肉减少症的截断值设定为骨骼肌指数<42.0cm2/m2（男性）和<31.2cm2/m2（女性），即最低性别特定四分位数。与非肌肉减少症患者相比，肌肉减少症患者更常吸烟（61%比 48%，p<0.001），更常处于疾病晚期（III-IV 期，p=0.004），年龄更大（67 岁比 63 岁，p<0.001），并且在治疗前经历了更多的症状，如吞咽困难（≥2 级，p<0.001）。除了线性预测因子外，肌肉减少症仅对医生评估的≥3 级吞咽困难（放疗期间第 3-6 周，p<0.01）具有统计学意义。然而，肌肉减少症并没有改善这些 NTCP 模型的性能（p>0.99）。
HNC 患者的肌肉减少症是放射性诱导的医生评估的急性≥3 级吞咽困难的独立预后因素，这可能是因为其对吞咽肌肉的影响。然而，加入肌肉减少症并没有改善 NTCP 模型的性能。
