Evaluation of Sarcopenia, Frailty, and Inflammation on Adverse Events and Survival Outcomes in Patients with Oral Cavity Squamous Cell Carcinoma under Adjuvant Chemoradiotherapy

Abstract

In this study, we aimed to evaluate the prognostic impact of sarcopenia, five-item modified frailty index (mFI-5), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) in patients with oral cavity squamous cell carcinoma (OSCC) treated with adjuvant chemoradiotherapy (CRT) and their survival outcomes. We retrospectively enrolled 175 patients with OSCC undergoing adjuvant CRT between 2011 and 2018, who were divided into groups with (n = 112) and without (n = 63) sarcopenia. Logistic regression analysis and Cox proportional hazards models were used to determine prognostic factors for CRT-related toxicity, three-year overall survival (OS), and disease-free survival (DFS). Sarcopenia and high PLR were independently associated with CRT-induced anemia (CIA); advanced tumor stage was related to poor three-year OS. CRT and survival did not differ by mFI-5 and NLR. Our results indicate that sarcopenia and high PLR are significant predictors of adjuvant CRT, increasing toxicity outcomes and indicating worse short-term OS. Accurately identifying sarcopenia and high PLR in patients with OSCC is critical to help better select candidates for adjuvant CRT to improve their outcomes.

Investigating sarcopenia, physical activity, and inflammation biomarkers in newly diagnosed oral cancer patients undergoing curative treatment: A prospective longitudinal study

“…In our previous retrospective studies, 56 , 57 we used a regular head and neck computed tomography slice at the level of the third cervical vertebra to measure skeletal muscle mass and to calculate the SMI. Significant association was found between sarcopenia and curative treatment-related toxicities and survival.…”

Effects of systemic inflammation and frailty on survival in elderly cancer patients: Results from the INSCOC study

“…Identifying the elderly cancer patients at higher risks of adverse treatment outcomes and mortality is a clinical priority. Two novel clinical prognostic indicators receiving increasing attention across different cancer types include frailty and elevated neutrophil-to-lymphocyte ratio (NLR, a marker of systemic inflammation) ( 1 ). Frailty is a state of vulnerability, and it is recognized as a strong predictor of adverse clinical outcomes ( 2 ).…”