Chargi Najiba, Bril Sandra I, Smid Ernst J, de Jong Pim A, de Bree Remco
Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Quant Imaging Med Surg. 2022 Jun;12(6):3024-3033. doi: 10.21037/qims-21-911.
Low skeletal muscle mass is associated with adverse outcomes in patients with cancer. For patients with head and neck cancer (HNC), skeletal muscle mass is often assessed at the third cervical vertebra on head and neck imaging. Due to the unavailability of standardized cut-off values for low skeletal muscle mass in patients with head and cancer, there is heterogeneousness of cut-off values for low skeletal muscle mass described in literature. Therefore, we aim to provide standardized cut-off values for low skeletal muscle mass in HNC patients.
A retrospective cohort study was performed. Between 2008 and 2018, HNC patients with head and neck imaging were included. Skeletal muscle area (SMA) was manually delineated at the level of the third cervical vertebra and corrected for patients squared height to obtain the cervical skeletal muscle mass index. Gender and body-mass index specific cut-off values for low skeletal muscle mass were calculated based on mean cervical skeletal muscle mass index minus 2 standard deviations as suggested in literature.
Of the 1,415 included patients, the majority was male (69.8%) and had a body mass index below 25 kg/m (59.2%). A primary tumor localization in the oropharynx (35.3%) and a tumor, node, metastasis stage IV tumor (60.5%) were most frequently observed. Cervical skeletal muscle mass index was significantly correlated with gender (r=0.4, P<0.01) and body mass index (r=0.4, P<0.01). For male patients with a body mass index <25 and ≥25 kg/m, a cervical skeletal muscle mass index of respectively ≤6.8 and ≤8.5 cm/m was defined for low skeletal muscle mass. For female patients with a body mass index <25 and ≥25 kg/m, a cervical skeletal muscle mass index of respectively ≤5.3 and ≤6.4 cm/m was defined for low skeletal muscle mass.
This study is the first to provide standardized cut-off values for low skeletal muscle mass at the level of the third cervical vertebra in patients with HNC. This information may aid in the uniformity of low skeletal muscle mass definition in research.
低骨骼肌质量与癌症患者的不良预后相关。对于头颈癌（HNC）患者，骨骼肌质量通常在头颈影像学检查的第三颈椎水平进行评估。由于缺乏头颈癌患者低骨骼肌质量的标准化临界值，文献中描述的低骨骼肌质量临界值存在异质性。因此，我们旨在提供HNC患者低骨骼肌质量的标准化临界值。
进行了一项回顾性队列研究。纳入2008年至2018年间有头颈影像学检查的HNC患者。在第三颈椎水平手动勾勒骨骼肌面积（SMA），并根据患者身高平方进行校正，以获得颈椎骨骼肌质量指数。根据文献建议，以平均颈椎骨骼肌质量指数减去2个标准差为基础，计算出低骨骼肌质量的性别和体重指数特异性临界值。
在纳入的1415例患者中，大多数为男性（69.8%），体重指数低于25kg/m²的患者占59.2%。最常见的原发肿瘤部位是口咽（35.3%），肿瘤、淋巴结、转移分期为IV期的肿瘤（60.5%）。颈椎骨骼肌质量指数与性别（r=0.4，P<0.01）和体重指数（r=0.4，P<0.01）显著相关。对于体重指数<25kg/m²和≥25kg/m²的男性患者，低骨骼肌质量的颈椎骨骼肌质量指数分别定义为≤6.8cm/m²和≤8.5cm/m²。对于体重指数<25kg/m²和≥25kg/m²的女性患者，低骨骼肌质量的颈椎骨骼肌质量指数分别定义为≤5.3cm/m²和≤6.4cm/m²。
本研究首次提供了HNC患者第三颈椎水平低骨骼肌质量的标准化临界值。这些信息可能有助于研究中低骨骼肌质量定义的统一。
