Prevalence and Impact of Computed Tomography–Defined Sarcopenia on Survival in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer: A Systematic Review

Abstract

Sarcopenia is a known independent prognostic factor for decreased survival in patients with head and neck cancer, yet its importance for the growing number of younger patients diagnosed with human papillomavirus (HPV) positive oropharyngeal carcinoma (OPC+) has not been established. This systematic literature review aimed to determine the prevalence and impact of computed tomography (CT)-defined sarcopenia on survival outcomes for adult patients (>18 years) with OPC+ undergoing any treatment modality. Prospective studies were searched for using PubMed, Embase, CENTRAL, CINAHL and Web of Science up until and including February 2022. Bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In total, nine studies (total pooled patients with OPC+ n=744) were identified and included in this review; two at low, six at moderate, and one at high risk of bias. All studies varied in sarcopenia assessment methods and skeletal muscle index threshold cut-off values. These studies demonstrated the cumulative prevalence of sarcopenia for patients with OPC+ to be 42.9% (95%CI: 37.8-47.9). While overall survival (three studies, n=253) and progression-free survival (one study, n=117) was lower in sarcopenic patients with OPC+, this was not statistically significant. GRADE certainty of evidence for impact of pre-treatment sarcopenia on overall survival was low and progression-free survival very low. Although these studies showed there to be a high prevalence of pre-treatment sarcopenia in patients with OPC+, which may decrease survival, the impact on progression-free survival is very uncertain. Further, high quality research utilizing consistent sarcopenia definitions and assessment methods that are conducted specifically in OPC+ is required to strengthen evidence certainty and determine if sarcopenia is an independent prognostic factor for this population.