Sarcopenia may predict recurrence in patients with head and neck cancer.

BACKGROUND: Malnutrition is a major consequence of head and neck cancer (HNC), often leading to decreased skeletal muscle mass and impacting survival. The goal of this study is to determine the effect of sarcopenia, as defined by skeletal muscle index (SMI), on survival in patients with HNC. METHODS: This is a retrospective review of patients with HNC treated with surgery and/or radiation at a single tertiary care institute. All had pre-treatment imaging available for skeletal muscle index (SMI) measurements, and SMI was calculated at the level of the 3rd cervical vertebra. Sarcopenia was defined as an SMI < 41 cm2/m2 in females and as <43 cm2/m2 in underweight or healthy weight males. Sarcopenia was defined as <53 cm2/m2 in overweight or obese males. Chi-square analysis was performed to compare recurrence and survival rates, and survival analysis was performed via Kaplan-Meir curve. RESULTS: Hundred and twelve patients with HNC were evaluated, 84 men and 28 women with an average age of 60.9 years. Tumors were primarily located in the oral cavity (24.1%) and oropharynx (42%). The majority (69.6%) underwent surgery. Mean body mass index prior to treatment was 28. Sixty-nine patients (61.6%) in our cohort had low SMI. Mean follow-up was 3.9 ± 2.2 years. Recurrence rate was 26% in those with low SMI versus 2% in those without. Patients with low SMI were more likely to have a recurrence (p = 0.02). Overall survival was 72.5% in those with low SMI and 81% in those with normal SMI (p = 0.09). CONCLUSIONS: Defining sarcopenia as a low skeletal muscle index at the third cervical vertebra is clinically relevant. This study demonstrates that low SMI at this level, and thus sarcopenia, was strongly associated with higher rates of recurrence.

Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer.

OBJECTIVE: Sarcopenia, characterized by decreased skeletal muscle mass, is associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. The effect of sarcopenia on swallowing following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and swallowing dysfunction in patients treated for HNC. STUDY DESIGN: Retrospective cohort study. SETTING: Academic medical center. METHODS: Pretreatment sarcopenia was assessed using the skeletal muscle index calculated from cross-sectional imaging at the third cervical vertebra. Feeding tube dependence, patient-reported dysphagia, and swallowing safety were assessed before and after treatment with the Functional Oral Intake Scale, Eating Assessment Tool-10, and Penetration Aspiration Scale, respectively. The association between sarcopenia and swallowing dysfunction was evaluated. RESULTS: A total of 112 patients were included, 84 males (75%) and 28 females (25%). A total of 69 (61.6%) had sarcopenia prior to initiating HNC therapy. Sarcopenia was significantly associated with an elevated risk of patient-reported dysphagia (odds ratio [OR] = 2.71 [95% confidence interval, CI, 1.12-6.79]; P < .05). Multivariate logistic regression demonstrated that sarcopenia (OR = 15.18 [95% CI, 1.50-453.53]; P < .05) is an independent predictor for aspiration following treatment for HNC. CONCLUSION: Patients with pretreatment sarcopenia had higher rates of dysphagia before treatment and were more likely to develop aspiration after completion of HNC therapy. Sarcopenia is readily measured using cross-sectional imaging and may be useful for identifying patients at risk of swallowing dysfunction and those most likely to benefit from prehabilitation efforts.

CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study.

BACKGROUND: For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. OBJECTIVE: To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. METHODS: Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. CONCLUSIONS: In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.