Lokal İleri Baş Boyun Kanserinde Prognozu Öngören Bir Parametre Olarak Sarkopeninin Değerlendirilmesi

Abstract

Erul E. Evaluation of sarcopenia as a prognostic parameter of poor outcome in locally advanced head and neck cancer, Hacettepe University Faculty Of Medicine Department Of Internal Medicine, Thesis Of Specialization in Medicine, Ankara, 2022. Head and neck cancer (HNC) is a major global health problem with a worldwide annual incidence of more than 890,000 patients and 450,000 deaths. Therapy for patients with locally advanced HNC (LA-HNC) is multimodal, best treated by combined-modality therapy, either surgery and postoperative adjuvant therapy or definitive chemoradiation (CRT). There are multiple prognostic factors that are not modifiable (e.g., age, comorbidities, and type of surgery), our focus should be on factors that could be modified or ameliorated before CRT. The presence of sarcopenia is of great interest because it is associated with worse outcomes and may be addressed before CRT. Since the evaluation of a sarcopenic patient is high-cost and time-consuming, cervical CTs which are routinely performed prior to radiotherapy modality have emerged as an effective method to evaluate sarcopenia without additional radiation exposure, or burden to the patient. In this study, we aimed to investigate the prognostic value of sarcopenia on recurrence and survival in patients with advanced HNSCC. A retrospective cohort study was conducted. All patients diagnosed with LA-HNC and treated with CRT in primary or postoperative settings between 2014 and 2018 in our tertiary referral center were screened for inclusion. Inclusion criteria for this study required that patients had CT imaging of the head and neck area within one month before CRT. The skeletal muscle area was estimated at the C3 vertebra level, and, thereafter, it was converted via a special equation to the skeletal muscle area at L3. 123 patients (110 men, 89.4%) with locally advanced head and neck cancer treated between the periods 2014 to 2018 were enrolled in the study. The median (range) age was 61 (31–87) years, and 34.1% were 65 years or older. The most common subsite was laryngeal carcinomas (63.4%) followed by oral cavity (19.5%) then hypopharynx (8.1%). The majority of patients had Stage IV disease (69 patients–56.1%) followed by stage III (n = 44, %35.8), and stage II (n =10, %8.1). Before radiotherapy, 42 (34.1%) patients were malnourished according to albumin level (<4 gr/dl), while 70 (56.9%) of the patients were sarcopenic. In multivariate analyses, pretreatment sarcopenia was associated with lower DFS (HR: 2.60, 95% CI (1.38-4.87), p=0.003). OS was significantly shorter in the presence of sarcopenia (HR: 2.86, 95% CI (1.40-5.85), p=0.004). Patients with sarcopenia experienced radiotherapy-related toxicities such as mucositis (OR=2.96; %95 CI (1.24-7.04), p= 0.014), dysphagia (OR= 3.60; %95 CI (1.56- 8.31), p= 0.003) and xerostomia (OR= 2.57; 95% CI (1.10-6.38); p <0.05) more than non-sarcopenic patients. Our study showed that low muscle mass in sarcopenia analysis (C3) performed with simulated CT for RT is associated with shorter DFS, OS and can be used as a poor prognostic indicator. Close nutritional monitoring before and after CRT is valuable in these patients.