Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga Biomedical Research Institute and BIONAND Platform (IBIMA), 29010 Malaga, Spain.
Department of Endocrinology and Nutrition, QuironSalud Malaga Hospital, 29004 Malaga, Spain.
Nutrients. 2024 Jan 29;16(3):387. doi: 10.3390/nu16030387.
Head and neck cancer (HNC) is a prevalent and aggressive form of cancer with high mortality rates and significant implications for nutritional status. Accurate assessment of malnutrition in patients with HNC is crucial for optimizing treatment outcomes and improving survival rates. This study aimed to evaluate the use of ultrasound techniques for predicting nutritional status, malnutrition, and cancer outcomes in patients with HNC. A total of 494 patients with HNC were included in this cross-sectional observational study. Various tools and body composition measurements, including muscle mass and adipose tissue ultrasound evaluations, were implemented. Using regression models, we mainly found that high levels of RF-CSA (rectus femoris cross-sectional area) were associated with a decreased risk of malnutrition (as defined with GLIM criteria (OR = 0.81, 95% CI: 0.68-0.98); as defined with PG-SGA (OR = 0.78, 95% CI: 0.62-0.98)) and sarcopenia (OR = 0.64, 95% CI: 0.49-0.82) after being adjusted for age, sex, and BMI. To predict the importance of muscle mass ultrasound variables on the risk of mortality, a nomogram, a random forest, and decision tree models were conducted. RF-CSA was the most important variable under the random forest model. The obtained C-index for the nomogram was 0.704, and the Brier score was 16.8. With an RF-CSA < 2.7 (AUC of 0.653 (0.59-0.77)) as a split, the decision tree model classified up to 68% of patients as possessing a high probability of survival. According to the cut-off value of 2.7 cm, patients with a low RF-CSA value lower than 2.7 cm had worse survival rates ( < 0.001). The findings of this study highlight the importance of implementing ultrasound tools, for accurate diagnoses and monitoring of malnutrition in patients with HNC. Adipose tissue ultrasound measurements were only weakly associated with malnutrition and not with sarcopenia, indicating that muscle mass is a more important indicator of overall health and nutritional status. These results have the potential to improve survival rates and quality of life by enabling early intervention and personalized nutritional management.
头颈部癌症（HNC）是一种普遍且侵袭性强的癌症，死亡率高，对营养状况有重大影响。准确评估 HNC 患者的营养不良对于优化治疗结果和提高生存率至关重要。本研究旨在评估超声技术在预测 HNC 患者营养状况、营养不良和癌症结局方面的应用。这项横断面观察性研究共纳入了 494 名 HNC 患者。使用多种工具和身体成分测量方法，包括肌肉质量和脂肪组织超声评估。通过回归模型，我们主要发现高 RF-CSA（股直肌横截面积）水平与营养不良（根据 GLIM 标准定义（OR = 0.81，95%CI：0.68-0.98）；根据 PG-SGA 定义（OR = 0.78，95%CI：0.62-0.98））和肌肉减少症（OR = 0.64，95%CI：0.49-0.82）风险降低相关，且在调整年龄、性别和 BMI 后。为了预测肌肉质量超声变量对死亡率的重要性，我们进行了列线图、随机森林和决策树模型分析。在随机森林模型中，RF-CSA 是最重要的变量。列线图的获得 C 指数为 0.704，Brier 评分为 16.8。以 RF-CSA<2.7（AUC 为 0.653（0.59-0.77））为分割，决策树模型将高达 68%的患者分类为具有高生存概率。根据 2.7cm 的截断值，RF-CSA 值较低（<2.7cm）的患者生存率较差（<0.001）。这项研究的结果强调了在 HNC 患者中实施超声工具进行准确诊断和监测营养不良的重要性。脂肪组织超声测量与营养不良仅呈弱相关，与肌肉减少症无关，表明肌肉质量是整体健康和营养状况的更重要指标。这些结果有可能通过早期干预和个性化营养管理来提高生存率和生活质量。
