Sarcopenia is a predictor for overall survival in elderly patients with head and neck cancer

Purpose or Objective Low skeletal muscle mass (SMM) is associated with negative outcomes in cancer patients. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria the definition of sarcopenia includes low SMM and low muscle function (MF; strength and/or performance). We investigated the relation between SMM, MF and overall survival (OS) in a group of elderly patients with head and neck squamous cell carcinoma (HNSCC). Material and Methods A retrospective study was performed in 85 elderly (³70- year old) patients who had a geriatric assessment before treatment of HNSCC between April 2015 and February 2018. Pre-treatment SMM was measured at the level of C3 and converted to SMM at the level of L3 using a previously published formula. A lumbar SMI <43.2cm²/m² was used to define low SMM. Handgrip strength and walking speed were measured using a hand dynamometer and the 4- meter gait speed test. Sarcopenia was classified according to the EWGSOP criteria. The prognostic value of SMM, MF and sarcopenia was investigated. Results Of the 85 included patients; 69 patients (81.2%) had low SMI, 50 patients (58.8%) had low HGS and 58 patients (68.2%) had low gait speed. According to the EWGSOP criteria, 41 patients (48.2%) were classified as sarcopenic. The median follow-up time was 11.14 months (IQR 3.64- 21.83 months); 33 patients (38.8%) died during the study period; 21 patients with sarcopenia and 12 patients without sarcopenia. The median overall survival was significantly worse for patients with sarcopenia (7.36 months; IQR 3.088-18.596) compared with patients with no sarcopenia (13.22 months; IQR 5.216-26.891) (HR 2.283; 95% CI 1.121-4.653; log rank test p=0.023). SMM or MF alone were not significant predictors of OS. In multivariate analysis, sarcopenia remained a predictor of OS when corrected for age, BMI and comorbidity (HR 2.014, 95% CI 0.980-4.140, p=0.030). In subgroup analyses according to TNM-stage, treatment intention and sarcopenia, sarcopenia was only a statically significant prognostic factor in patients with TNM-stage I-III (HR 9.193; 95%CI 1.073-78.739; p=0.043) and in patients with curative treatment intention (HR 2.800; 95%CI 1.140- 6.877; p=0.025). Conclusion Skeletal muscle mass index and muscle function (as determined by muscle strength or physical performance measurements) were solely not prognostic in elderly head and neck cancer patients, but the combination of both was prognostic for overall survival. Therefore, sarcopenia should preferably (if muscle function data are available) be defined by the EWGSOP criteria and not by radiologically assessed skeletal muscle mass only.