Abstract 367P
Background
Radiologically defined sarcopenia has been associated with adverse oncological outcomes, with CT imaging being an expedient tool for determining sarcopenia in cancer patients. The objective of this meta-analysis is to assess the association of sarcopenia defined on CT head and neck with survival in head and neck cancer patients.
Methods
Following a PROSPERO-registered protocol, three reviewers conducted a systematic review of the PubMed, Embase and Cochrane Library for observational studies that reported the presence of sarcopenia in association with mortality estimates. Two blinded reviewers extracted data and evaluated the quality of included studies using the Quality of Prognostic Studies tool and the Grading of Recommendations, Assessment, Development and Evaluations framework. A meta-analysis was conducted using maximally adjusted hazard ratios for mortality estimates and correlation coefficients. Heterogeneity was investigated using meta-regression and subgroup analyses.
Results
From 33 studies (9083 participants), sarcopenia was associated with poorer overall survival (HR, 2.09; 95% CI, 1.77 to 2.47; p = .01), disease-free survival (HR, 1.76; 95% CI, 1.38 to 2.24; p < .01) disease-specific survival (HR, 2.24; 95% CI, 1.82 to 3.67; p < .01), progression-free survival (HR, 2.24; 95% CI, 1.82 to 3.67; p < .01) and increased chemotherapy or radiotherapy toxicity (RR, 2.28; 95% CI, 1.31 to 3.95; p < .01). Overall survival was significantly poorer in studies with mean BMI <25 kg/m2 compared with studies with mean BMI ≥25 kg/m2. The observed association between sarcopenia and overall survival remained significant across different locations of cancer, treatment modality, tumor stages and geographical region, and did not differ between univariate and multivariate hazard ratios. Statistically significant correlations were observed between C3 and L3 cross-sectional area, skeletal muscle mass and skeletal muscle index.
Conclusions
Among patients with head and neck cancers, CT-defined sarcopenia was consistently associated with poorer survival and greater toxicity. Our findings are easily applicable in clinical practice, by measuring sarcopenia at the C3 vertebra on routine staging CT scans.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
National University of Singapore.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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