van Heusden Hugo C, van Beers Maartje A, Schaeffers Anouk W M A, Swartz Emma, Swartz Justin E, de Bree Remco
Department of Head and Neck Surgical Oncology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands.
Br J Cancer. 2025 Jun 2. doi: 10.1038/s41416-025-03049-7.
Radiologically defined sarcopenia (RS), defined as a lack of skeletal muscle mass (SMM) measured on cross-sectional CT or MR imaging, is increasingly recognized as a significant prognostic determinant in head and neck cancer (HNC). A systematic literature search of Embase and Medline was performed to identify studies investigating the impact of pre-treatment sarcopenia on the prognosis of HNC patients. All available survival and other treatment-related outcomes were extracted and analyzed in a multi-level meta-analysis. Sixty-three studies comprising data from 14,804 patients were analyzed. The overall estimated log OR was 0.644 (95% CI = 0.505-0.783, p < 0.001), suggesting that patients with RS have a higher risk of worse outcomes. In 43 studies there was a significant effect of sarcopenia on survival, with a log OR of 0.808 (95% CI = 0.509-1.107, p < 0.001). In 15 studies RS was shown to be a risk factor for treatment-related complications (log OR = 0.669, 95% CI = 0.441-0.897, p < 0.001). We conclude that pre-treatment radiologically defined sarcopenia is a robust prognostic and predictive factor in HNC patients and is associated with worse survival and increased risk of treatment-related complications.
放射学定义的肌肉减少症（RS），即通过横断面CT或MR成像测量的骨骼肌质量（SMM）缺乏，越来越被认为是头颈癌（HNC）的一个重要预后决定因素。对Embase和Medline进行了系统的文献检索，以确定研究治疗前肌肉减少症对HNC患者预后影响的研究。在多层次荟萃分析中提取并分析了所有可用的生存及其他与治疗相关的结果。分析了63项研究，包括来自14804名患者的数据。总体估计对数OR为0.644（95%CI = 0.505 - 0.783，p < 0.001），表明患有RS的患者预后较差的风险更高。在43项研究中，肌肉减少症对生存有显著影响，对数OR为0.808（95%CI = 0.509 - 1.107，p < 0.001）。在15项研究中，RS被证明是治疗相关并发症的一个危险因素（对数OR = 0.669，95%CI = 0.441 - 0.897，p < 0.001）。我们得出结论，治疗前放射学定义的肌肉减少症是HNC患者一个可靠的预后和预测因素，与较差的生存率及治疗相关并发症风险增加相关。
