BACKGROUND AND PURPOSE Sarcopenia is emerging as an adverse prognostic factor for survival and complication risk in cancer patients. This study aims to determine the impact of sarcopenia on survival and late toxicity in a large cohort of head and neck squamous cell carcinoma (HNSCC) patients treated with definitive (chemo)radiotherapy ((C)RT). MATERIALS AND METHODS HNSCC patients treated with definitive (C)RT from January 2007 to June 2016 were included. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscles at level C3. The impact of sarcopenia on overall survival (OS) and disease-free survival (DFS) was evaluated using the Kaplan-Meier method. Multivariable association models were developed to assess the impact of sarcopenia on late toxicity. RESULTS The study population was composed of 750 HNSCC patients. Cut-off values for sarcopenia were set at SMI < 42.4 cm2/m2 (men) and <30.6 cm2/m2 (women) corresponding lowest gender specific quartile. Sarcopenic patients had significantly poorer survival rates, especially those with lower performance status and locally advanced disease. In oropharyngeal cancer patients, survival was more determined by p16 status than by sarcopenia. In multivariable analysis, sarcopenia was associated with worse OS (HR 0.72, p = 0.012) and DFS (HR 0.67, p = 0.001). In multivariable association models, sarcopenia was associated with physician-rated xerostomia six months after treatment (OR 1.65, p = 0.027) and physician-rated dysphagia six and twelve months after treatment (OR 2.02, p = 0.012 and 2.51, p = 0.003, respectively). CONCLUSION Sarcopenia in HNSCC patients receiving definitive (C)RT is an independent prognostic factor for worse survival outcomes and is associated with physician-rated toxicity.

中文翻译：

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肌肉减少症对接受放射治疗的头颈癌患者的生存率和晚期毒性的影响

背景和目的 肌肉减少症正在成为癌症患者生存和并发症风险的不良预后因素。本研究旨在确定肌肉减少症对接受明确（化学）放疗（（C）RT）治疗的大量头颈部鳞状细胞癌（HNSCC）患者的生存率和晚期毒性的影响。材料和方法 纳入 2007 年 1 月至 2016 年 6 月接受确定性 (C)RT 治疗的 HNSCC 患者。使用 C3 水平的骨骼肌通过放射计划计算机断层扫描 (CT) 扫描评估肌肉减少症。使用 Kaplan-Meier 方法评估肌肉减少症对总生存期 (OS) 和无病生存期 (DFS) 的影响。开发了多变量关联模型来评估肌肉减少症对晚期毒性的影响。结果 研究人群由 750 名 HNSCC 患者组成。肌肉减少症的临界值设定为 SMI < 42.4 cm2/m2（男性）和 <30.6 cm2/m2（女性）对应的最低性别特异性四分位数。少肌症患者的生存率显着降低，尤其是体能状况较差和局部晚期疾病的患者。在口咽癌患者中，生存率更多地取决于 p16 状态而不是肌肉减少症。在多变量分析中，肌肉减少症与较差的 OS（HR 0.72，p = 0.012）和 DFS（HR 0.67，p = 0.001）相关。在多变量关联模型中，肌肉减少症与治疗后 6 个月的医生评定的口干症（OR 1.65，p = 0.027）和治疗后 6 个月和 12 个月的医生评定的吞咽困难相关（OR 2.02，p = 0.012 和 2.51，p = 0.003，分别）。