Is sarcopenia associated with long-term survival after head and neck surgery?
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.
Sarcopenia may be associated with decreases in long-term survival in patients with head and neck cancer who are undergoing surgery.
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.
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.
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.
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.
Stone L, Olson B, Mowery A, et al. Association Between Sarcopenia and Mortality in Patients Undergoing Surgical Excision of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online June 06, 2019. doi:10.1001/jamaoto.2019.1185
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: