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Original Investigation
June 6, 2019

Association Between Sarcopenia and Mortality in Patients Undergoing Surgical Excision of Head and Neck Cancer

Author Affiliations
  • 1Medical student, School of Medicine, Oregon Health and Science University, Portland
  • 2Department of Pediatrics, Oregon Health and Science University, Portland
  • 3School of Medicine, Oregon Health and Science University, Portland
  • 4Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland
  • 5Department of Otolaryngology/Head and Neck Surgery, University of Illinois at Chicago
  • 6Operative Care Division, Portland Veterans’ Affairs Health Care System, Portland, Oregon
JAMA Otolaryngol Head Neck Surg. Published online June 6, 2019. doi:10.1001/jamaoto.2019.1185
Key Points

Question  Is sarcopenia associated with long-term survival after head and neck surgery?

Findings  In this cohort study with imaging analysis, 260 patients with head and neck cancer who had preoperative sarcopenia experienced decreased 2-year overall survival (71.9% vs 88.5%) compared with patients without sarcopenia. Decreased 5-year overall survival (36.5% vs 60.5%) was also noted.

Meaning  Sarcopenia may be associated with decreases in long-term survival in patients with head and neck cancer who are undergoing surgery.

Abstract

Importance  Sarcopenia, or the loss of muscle mass, is associated with poor treatment outcomes in a variety of surgical fields. However, the association between sarcopenia and long-term survival in a broad cohort of patients with head and neck cancer (HNC) is unknown.

Objective  To determine whether sarcopenia is associated with long-term survival in patients undergoing major head and neck surgery for HNC.

Design, Setting, and Participants  A retrospective medical records review was conducted at a tertiary care academic hospital. Two hundred sixty patients undergoing major head and neck ablative procedures with cross-sectional abdominal imaging performed within 45 days prior to surgery were included in the analysis. The study was conducted from January 1, 2005, to December 31, 2016. Data analysis was performed from June 1, 2018, to February 28, 2019.

Interventions  Measurement of cross-sectional muscle area at the L3 vertebra level.

Main Outcomes and Measures  Two- and 5-year overall survival were the primary outcomes.

Results  Of the 260 patients included in the study, 193 were men (74.2%); mean (SD) age was 61.1 (11) years. Sarcopenia was present in 144 patients (55.4%). Two-year overall survival was 71.9% of the patients (n = 82) in the sarcopenia group compared with 88.5% of the patients (n = 85) in the nonsarcopenia group (odds ratio [OR], 0.33; 95% CI, 0.16-0.70). At 5 years, overall survival was 36.5% in patients (n = 23) with sarcopenia and 60.5% in patients (n = 26) without sarcopenia (OR, 0.38; 95% CI, 0.17-0.84). On multivariate analysis, sarcopenia was a significant negative predictor of both 2-year (OR, 0.33; 95% CI, 0.14-0.77) and 5-year (OR, 0.38; 95% CI, 0.17-0.84) overall survival.

Conclusions and Relevance  Sarcopenia appears to be a significant negative predictor of long-term overall survival in patients with HNC undergoing major head and neck surgery. Sarcopenia may be accurately assessed on cross-sectional imaging and may be useful clinically as a prognostic variable and as an area for intervention to improve treatment outcomes.

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