Sarcopenic OPSCC Patients May Benefit Most From Upfront Surgery

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Sarcopenia should be considered during treatment decision-making for localised oropharyngeal squamous cell carcinoma (OPSCC), suggest researchers who found that outcomes for patients with low lean muscle mass are better with upfront surgery than radiotherapy (RT). 

“In this single-institution study, we report that patients with normal skeletal musculature at diagnosis benefit equally from primary surgical resection or definitive RT”, say Daniel Clayburgh and co-investigators from Oregon Health & Science University in Portland, USA.

“However, upfront ablative surgery for sarcopenic patients was associated with an increase in overall survival [OS] and disease-specific survival compared with their counterparts who received definitive RT”, they write in JAMA Otolaryngology–Head & Neck Surgery.

“As such, these data suggest that sarcopenia may be a clinically significant variable when considering treatment modalities for patients with localized OPSCC”, they advise.

The cohort study included 245 patients, aged an average of 62.3 years, who were treated for stage T1–T2, N0–N2 OPSCC between 2005 and 2017. Overall, 55.1% of patients were diagnosed with sarcopenia, defined as a skeletal muscle mass of less than 52.4 cm2/m2 in men and less than 38.5 cm2/m2 in women. 

Among patients with normal muscle mass, the survival outcomes were independent of primary treatment modality and there was no survival benefit associated with a positive human papillomavirus (HPV) status. 

By contrast, both OS and disease-specific survival were significantly better among the patients with sarcopenia who underwent primary resection compared with those given definitive RT, with hazard ratios (HRs) for death of 0.37 and 0.22, respectively.

These surgical benefits persisted after considering HPV status. And when propensity score matching was performed for age, sex, tumour stage or nodal status, smoking history, HPV status and other factors, there remained a significant benefit with surgery for sarcopenia patients, with HRs for OS and disease-free survival of 0.33 and 0.17, respectively.

Multivariable analysis showed that OS was significantly and positively associated with a smoking history of less than 10 pack–years (HR=0.26) and upfront surgery (HR=0.25), but was poor for patients with a negative HPV status (HR=1.29) and a body mass index below 18.5 kg/m2 (HR=19.59).

“[T]hese results highlight the unique biological state of the sarcopenic patient, and suggest that patients with excessive muscle loss at diagnosis may differentially respond to treatment modalities compared with their nonsarcopenic counterparts”, write Daniel Clayburgh et al.

They hypothesise that sarcopenia may reduce tolerance for RT and increase the likelihood of long-term RT-related adverse events, such as dysphagia, or that other sarcopenia-related factors may reduce immune surveillance or have other effects on a patient that could impact on RT efficacy.

“Further study into this observation will be required to better understand these factors and to the test the utility of the clinical assessment of sarcopenia in clinical practice”, the team concludes. 

Reference  

Olson B, Edwards J, Stone L, et al. Association of sarcopenia with oncologic outcomes of primary surgery or definitive radiotherapy among patients with localized oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 2020; Advance online publication 11 June 2020. doi:10.1001/jamaoto.2020.1154