School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Nutrition and Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia.
Adv Nutr. 2022 Dec 22;13(6):2433-2444. doi: 10.1093/advances/nmac076.
Sarcopenia is a known independent prognostic factor for decreased survival in patients with head and neck cancer; yet, its importance for the growing number of younger patients diagnosed with human papillomavirus (HPV)-positive oropharyngeal carcinoma (OPC+) has not been established. This systematic literature review aimed to determine the prevalence and impact of computed tomography (CT)-defined sarcopenia on survival outcomes for adult OPC+ patients (>18 y) undergoing any treatment modality. Prospective studies were searched using PubMed, Embase, CENTRAL, CINAHL, and Web of Science up until and including February 2022. Bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In total, 9 studies (total pooled OPC+ patients, n = 744) were identified and included in this review; 2 at low, 6 at moderate, and 1 at high risk of bias. All studies varied in sarcopenia assessment methods and skeletal muscle index threshold cutoff values. These studies demonstrated the cumulative prevalence of sarcopenia for OPC+ patients to be 42.9% (95% CI: 37.8%, 47.9%). While overall survival (3 studies, n = 253) and progression-free survival (1 study, n = 117) was lower in sarcopenic OPC+ patients, this was not statistically significant. GRADE certainty of evidence for impact of pretreatment sarcopenia on overall survival was low and progression-free survival was very low. Although these studies showed there to be a high prevalence of pretreatment sarcopenia in patients with OPC+, which may decrease survival, the impact on progression-free survival is very uncertain. Further, high-quality research utilizing consistent sarcopenia definitions and assessment methods that are conducted specifically in OPC+ is required to strengthen evidence certainty and determine if sarcopenia is an independent prognostic factor for this population.
肌肉减少症是头颈部癌症患者生存率降低的已知独立预后因素；然而，对于越来越多被诊断为人乳头瘤病毒（HPV）阳性口咽癌（OPC+）的年轻患者，其重要性尚未确定。本系统文献综述旨在确定计算机断层扫描（CT）定义的肌肉减少症对接受任何治疗方式的成年 OPC+患者（>18 岁）的生存结果的患病率和影响。使用 PubMed、Embase、CENTRAL、CINAHL 和 Web of Science 对前瞻性研究进行了搜索，检索时间截至 2022 年 2 月。使用预后研究质量工具（QUIPS）评估偏倚，使用推荐评估、制定与评价（GRADE）系统评估证据确定性。共确定了 9 项研究（总共有 OPC+患者，n=744），并纳入本综述；2 项研究的偏倚风险低，6 项研究的偏倚风险中，1 项研究的偏倚风险高。所有研究的肌肉减少症评估方法和骨骼肌指数截断值均存在差异。这些研究表明，OPC+患者肌肉减少症的累积患病率为 42.9%（95%CI：37.8%，47.9%）。尽管在肌肉减少症 OPC+患者中，总生存率（3 项研究，n=253）和无进展生存率（1 项研究，n=117）较低，但无统计学意义。肌肉减少症对总生存率的影响的 GRADE 证据确定性为低，无进展生存率的证据确定性为极低。尽管这些研究表明 OPC+患者中存在高患病率的治疗前肌肉减少症，这可能会降低生存率，但对无进展生存率的影响非常不确定。此外，需要开展高质量的研究，使用一致的肌肉减少症定义和评估方法，并专门针对 OPC+进行研究，以加强证据确定性，并确定肌肉减少症是否是该人群的独立预后因素。
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