Colback Angela A, Arkfeld Daniel V, Paydar Alireza, Raslan Osama, Cates Daniel J, Abouyared Marianne
Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, California, USA.
Division of Neuroradiology, Department of Radiology, University of California Davis Medical Center, Sacramento, California, USA.
Head Neck. 2025 Jan;47(1):282-288. doi: 10.1002/hed.27903. Epub 2024 Aug 13.
Malnutrition is a major consequence of head and neck cancer (HNC), often leading to decreased skeletal muscle mass and impacting survival. The goal of this study is to determine the effect of sarcopenia, as defined by skeletal muscle index (SMI), on survival in patients with HNC.
This is a retrospective review of patients with HNC treated with surgery and/or radiation at a single tertiary care institute. All had pre-treatment imaging available for skeletal muscle index (SMI) measurements, and SMI was calculated at the level of the 3rd cervical vertebra. Sarcopenia was defined as an SMI < 41 cm/m in females and as <43 cm/m in underweight or healthy weight males. Sarcopenia was defined as <53 cm/m in overweight or obese males. Chi-square analysis was performed to compare recurrence and survival rates, and survival analysis was performed via Kaplan-Meir curve.
Hundred and twelve patients with HNC were evaluated, 84 men and 28 women with an average age of 60.9 years. Tumors were primarily located in the oral cavity (24.1%) and oropharynx (42%). The majority (69.6%) underwent surgery. Mean body mass index prior to treatment was 28. Sixty-nine patients (61.6%) in our cohort had low SMI. Mean follow-up was 3.9 ± 2.2 years. Recurrence rate was 26% in those with low SMI versus 2% in those without. Patients with low SMI were more likely to have a recurrence (p = 0.02). Overall survival was 72.5% in those with low SMI and 81% in those with normal SMI (p = 0.09).
Defining sarcopenia as a low skeletal muscle index at the third cervical vertebra is clinically relevant. This study demonstrates that low SMI at this level, and thus sarcopenia, was strongly associated with higher rates of recurrence.
营养不良是头颈癌（HNC）的主要后果，常导致骨骼肌质量下降并影响生存。本研究的目的是确定由骨骼肌指数（SMI）定义的肌肉减少症对HNC患者生存的影响。
这是一项对在单一三级医疗机构接受手术和/或放疗的HNC患者的回顾性研究。所有患者术前均有可用于测量骨骼肌指数（SMI）的影像资料，并在第三颈椎水平计算SMI。肌肉减少症定义为女性SMI < 41 cm/m，体重过轻或正常体重男性SMI < 43 cm/m。超重或肥胖男性的肌肉减少症定义为SMI < 53 cm/m。采用卡方分析比较复发率和生存率，并通过Kaplan-Meir曲线进行生存分析。
共评估了112例HNC患者，其中84例男性和28例女性，平均年龄60.9岁。肿瘤主要位于口腔（24.1%）和口咽（42%）。大多数患者（69.6%）接受了手术。治疗前平均体重指数为28。队列中的69例患者（61.6%）SMI较低。平均随访时间为3.9 ± 2.2年。SMI低的患者复发率为26%，而SMI正常的患者复发率为2%。SMI低的患者更易复发（p = 0.02）。SMI低的患者总生存率为72.5%，SMI正常的患者为81%（p = 0.09）。
将第三颈椎水平的低骨骼肌指数定义为肌肉减少症具有临床相关性。本研究表明，该水平的低SMI，即肌肉减少症，与较高的复发率密切相关。
