Sarcopenia and Systemic Inflammation Synergistically Impact Survival in Oral Cavity Cancer

Abstract

Objectives Sarcopenia and systemic inflammation can affect survival of advanced‐stage oral squamous cell carcinoma (OSCC) patients; however, their reciprocal associations with survival outcomes are yet to be investigated. Study Design Retrospective review at a tertiary cancer center. Methods Patients with stage III‐IVB OSCC that underwent surgery and (chemo)radiotherapy at our institution between 2010 and 2015 were reviewed. Skeletal muscle index (SMI) was assessed using computed tomography scans at the C3 vertebra. Sarcopenia was defined at the lowest sex‐specific tertile for SMI. Systemic inflammation was estimated using the modified Glasgow prognostic score (mGPS), which ranges from 0 to 2 based on serum C‐reactive protein and albumin levels. The predictors of overall survival (OS) were evaluated using Cox regression models. Results A total of 174 patients were included in the study. The cut‐off values for sarcopenia were set at SMI <52.4 cm2/m2 (men) and < 36.2 cm2/m2 (women) corresponding to the lowest sex‐specific tertile. An mGPS 1–2 was independently associated with sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.06–3.97; P = .03). On multivariate analysis for OS, sarcopenia and mGPS 1–2 independently predicted OS (hazard ratio: 2.12; 95% confidence interval: 1.17–3.85; P = .01 and hazard ratio: 7.85; 95% confidence interval: 3.7–16.65; P < .001, respectively). Patients with both sarcopenia and mGPS 1–2 (vs. neither) had worse OS (hazard ratio: 16.80; 95% confidence interval: 6.01–46.99; P < .001). Conclusions Sarcopenia and systemic inflammation may exert a negative synergistic prognostic impact in advanced‐stage OSCC patients. Level of Evidence 4 Laryngoscope, 131:E1530–E1538, 2021

Prognostic impact of sarcopenia in patients with head and neck cancer treated with surgery or radiation: A meta-analysis

“…We screened the titles and abstracts of these studies and identified 83 potentially eligible studies. The full-text versions of these 83 studies were then inspected according to the exclusion criteria, and 18 studies involving 3,233 patients were determined to be eligible for inclusion in this study [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1). In these 18 studies, seven investigated patients treated with surgery [17, 20, 25-27, 31, 32] and 10 investigated patients treated with RT [15, 16, 18, 19, 21-24, 29, 30].…”

“…[31] used the psoas muscle mass index, and the study by Choi et al [21] used the skeletal muscle area of the neck. The remaining 16 studies used skeletal muscle mass index (SMI), with seven [15,18,23,25,[27][28][29] and nine [16,17,19,20,22,24,26,30,32] studies measuring the muscle area at the L3 and C3 spine levels, respectively. Eight studies [16, 18, 19, 22-24, 29, 30] in the RT group and six studies [17,20,[25][26][27]31] in the surgery group reported stage distribution between stage I, II and stage III, IV disease.…”

“…The remaining 16 studies used skeletal muscle mass index (SMI), with seven [15,18,23,25,[27][28][29] and nine [16,17,19,20,22,24,26,30,32] studies measuring the muscle area at the L3 and C3 spine levels, respectively. Eight studies [16, 18, 19, 22-24, 29, 30] in the RT group and six studies [17,20,[25][26][27]31] in the surgery group reported stage distribution between stage I, II and stage III, IV disease. Among them, 79.0% of the 1772 patients in the RT group had stage III, IV disease, whereas 63.4% of the 1026 patients in the surgery group had stage III, IV disease.…”

Association of Patient-Reported Outcomes and Nutrition with Body Composition in Women with Gynecologic Cancer Undergoing Post-Operative Pelvic Radiotherapy: An Observational Study

“…We obtained data regarding the neutrophil-lymphocyte ratio (NLR) as a systemic inflammatory marker from medical records. NLR was categorized as high or low using a cut-off of 3 [ 38 , 39 ]. The bowel V45, which indicates the bowel volume (mL) receiving a radiation dose of ≥45 Gy [ 9 ], was obtained from the patient’s radiotherapy plan.…”

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

“…Although sarcopenia, frailty status, and systemic inflammation are relatively well established as negative predictors of clinical outcomes in patients with HNC undergoing surgery [ 18 , 19 , 20 , 21 , 34 , 35 ], the value of these factors to predict patients with OSCC undergoing adjuvant CRT is unclear. The present study analyzed 175 patients with OSCC, among which 64% ( n = 112) had sarcopenia undergoing adjuvant CRT.…”