367P - Prevalence and association of sarcopenia with mortality in patients with head and neck cancer: A meta-analysis

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.