Introduction: Sarcopenia, or the loss of lean muscle mass, can be accurately measured on cross-sectional imaging at the L3 level. This measurement is a strong prognostic factor of adverse outcomes in many surgical fields, particularly in relation to pancreatic cancer, colon cancer, and other oncologic surgery. In the field of head and neck cancer, sarcopenia has been shown to be a strong predictor for wound complications in patients undergoing total laryngectomy, and a predictor of mortality in patients undergoing definitive radiation therapy; however, the prognostic value of sarcopenia for mortality in a broad cohort of head and neck surgery patients has not previously been studied. Thus, we performed this study with the objective to evaluate the prognostic significance of preoperative sarcopenia on long-term mortality in head and neck surgery patients.
Methods: A retrospective review was performed of 260 patients with head and neck cancer who underwent surgical excision as the primary treatment modality and with available cross-sectional abdominal imaging within 30 days prior to surgery between 2005 – 2016 in a tertiary care hospital. Measurements of abdominal wall and paraspinal skeletal muscle area at the cross-sectional L3 vertebral body were performed, normalized for height and compared to previously accepted sex-specific cutoff values to identify sarcopenia. Postoperative complications including all complications and wound complications were determined. 2-year and 5-year disease specific mortality and overall mortality were determined from follow up data.
Results: Sarcopenia was identified preoperatively in 144 (55%) patients. Patients with sarcopenia tended to be older (Cohen d=-0.69; 95% CI, -0.94- -0.44), male (OR, 1.93; 95% CI, 1.10-3.39), smokers (OR, 2.77; 95% CI, 1.30-5.89), and have higher Charlson Comorbidity Scores (Cohen d=-0.60; 95% CI, -0.85- -0.35), than patients without sarcopenia. Of 210 patients with 2-year follow up, 2-year overall survival was 71.9% in the sarcopenia group compared to 88% of patients in the non-sarcopenia group (p=0.003). Similarly, 2-year disease-specific survival was 80% in the sarcopenia group compared to 92% in the non-sarcopenic group (p=0.016). In 106 patients with 5-year survival data, 5-year overall survival was 36% in the sarcopenia group versus 60% in the non-sarcopenia group (p=0.015). On multivariate analysis, only sarcopenia was a significant predictor for 2-year disease specific mortality (OR 2.81; 95% CI, 1.19-6.62) and 5-year overall mortality (OR 2.66; 95% CI, 1.20-5.91).
Conclusion: Sarcopenia is a strong, independent negative prognostic indicator for 2-year disease specific mortality and 5-year overall mortality in patients with head and neck cancer who undergo surgery as their primary treatment modality. Future studies will be needed to better establish the utility of this measurement in clinical practice and potentially develop interventions to mitigate the risk of mortality in patients with sarcopenia.