Association between pretreatment obesity, sarcopenia, and survival in patients with head and neck cancer

Abstract

Background Body mass index (BMI), sarcopenia, and obesity‐related comorbidities have been associated with head and neck squamous cell carcinoma (HNSCC) progression. Methods We conducted a retrospective analysis of 441 normal‐weight, overweight, and obese HNSCC patients treated at Montefiore Medical Center (New York). Patients were grouped by BMI prior to treatment and assessed for differences in survival adjusting for comorbid conditions (cardiovascular disease and diabetes). Evidence of sarcopenia was also assessed using pretreatment abdominal CT scans in a subset of 113 patients. Results Prior to treatment, 55% of HNSCC patients were overweight or obese. Overweight/obese patients had significantly better overall survival (hazard ratio [HR] = 0.4, 95% CI: 0.3‐0.6) compared to normal‐weight patients, independent of comorbid conditions. Patients with sarcopenia had significantly poorer survival (HR = 2.1, 95% CI: 1.1‐3.9) compared to non‐sarcopenic patients, with the strongest association seen among overweight/obese patients. Conclusion Our data support the importance of sarcopenia assessment, in addition to BMI, among patients with HNSCC.

Low Skeletal Muscle Mass Impairs Quality of Life in Nasopharyngeal Carcinoma Patients Treated With Concurrent Chemoradiotherapy

“…In our study, the incidence rate of low SMM was 60.71%, which is higher than the incidence rates reported in other publications on low SMM in head and neck cancers, ranging from 6.6 to 64.6% (8,10,24,25). A possible explanation for this may be that the present study enrolled patients with locoregionally advanced cancers who were receiving CCRT, whereas more patients in early stages were included in prior studies.…”

When the Loss Costs Too Much: A Systematic Review and Meta-Analysis of Sarcopenia in Head and Neck Cancer

“…The former had a much higher risk than any other research (HR = 3.93, 95% CI; 2.36-6.55). Interestingly, the cutoff value they used was the same as that from three other included articles (18,21,29) (Table 1), but the incidence rate of sarcopenia was only 6.6%; the possible reasons for this are as follows: (a) 6.6% is for sarcopenia with visceral obesity in their study, (b) the locally advanced cancer stage is the distinguishing property, or (c) there might be potential bias that affected the incidence. The study by Van Rijn-Dekker et al, which will soon be published in full, was a meeting abstract that investigated a large-scale cohort of 750 patients with HNSCC, the incidence of sarcopenia was also low, i.e., as 25%, and the result was conservative and narrow (HR = 1.44, 95% CI: 1.12-1.84).…”

“…For example, Van Rijn-Dekker et al (26) found that sarcopenia is not a prognostic factor in early-stage HNSCC. Third, because Fattouh et al (29) only reported the positive HR in their multivariate analysis, the univariate meta-analysis included 10/11 of eligible primary studies; however, according to the principle of Cox regression, there is little chance that the conclusion of the meta-analysis will be affected. Finally, the reasons for the different statistical significance between Egger's test and the trim-and-fill method might derive from the low number of included studies; however, these studies are relatively new, and we did not receive replies from the authors of three conference articles with positive (49,50) and negative (51) results, which requires further evaluation after their official publication.…”

“…After the initial literature search on August 30, 2019, 11 studies (17, 18, 20-24, 26, 29, 33, 34), including one nested case-control study (29) and a meeting abstract (26), assessing 2,483 patients were pooled in the present meta-analysis. Of the patients involved, an average of 39.4% had sarcopenia (979 patients and 1,504 patients had and did not have sarcopenia, respectively, according to different cutoff values; Figure 1).…”

Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost

“…In patients undergoing radiotherapy for HNC, recent studies have demonstrated independent associations between sarcopenia with reduced survival and chemotherapy dose‐limiting toxicities ( 16–26 ) , although no studies have examined myosteatosis. The present study aimed to examine the association between CT‐defined sarcopenia and myosteatosis on overall survival (OS), treatment completion, unplanned hospital admissions and associated costs for patients undergoing radiotherapy ± other treatment modalities (surgery and/or systemic therapy) for HNC.…”