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Skeletal muscle mass, BMI predict survival in radiotherapy-treated HNSCC
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Skeletal muscle mass and BMI predicted outcomes for patients with head and neck squamous cell carcinoma who underwent radiotherapy, according to results of a single-center, retrospective study.
Significant weight loss is common in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy; however, prior studies designed to assess the effects of nutritional interventions failed to show an improvement in survival.
“Severe lean body mass (LBM) wasting that is resistant to nutritional support is the hallmark of cachexia, the paraneoplastic wasting syndrome associated with advanced cancer,” Aaron J. Grossberg, MD, PhD, radiation oncology resident at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “The resultant skeletal muscle depletion is strongly correlated with decreased survival in patients with other solid tumors.”
Grossberg and colleagues conducted their study to assess whether lean body mass prior to or after radiotherapy appeared associated with survival or locoregional control in patients with HNSCC.
The researchers evaluated 190 patients (men, n = 160; mean age at diagnosis, 57.7 years) with pathologically proven HNSCC who underwent whole-body PET/CT or abdominal CT scans before and after radiotherapy.
Researchers followed patients for a median 68.6 months, with a mean interval between pre- and post-radiotherapy CT imaging of 5.7 months.
Patients who presented with skeletal muscle depletion prior to treatment were older than patients with normal skeletal muscle (60.8 years vs. 56 years; P = .001).
Among men, mean estimated LBM decreased from 58.4 kg before radiotherapy to 51.6 kg after radiotherapy. Among women, mean estimated LBM decreased from 38 kg before radiotherapy to 35.7 kg after radiotherapy.
The number of patients with skeletal muscle depletion increased 30.5%, from 67 patients before radiotherapy to 125 patients after radiotherapy.
Skeletal muscle depletion prior to radiotherapy appeared significantly associated with shorter OS (HR = 1.92; 95% CI, 1.19-3.11) and disease-specific survival (HR = 1.87; 95% CI, 1.03-3.36).
Researchers reported a lower 5-year OS rate among those with pre-radiotherapy skeletal muscle depletion (62% vs. 75%).
Skeletal muscle depletion after radiotherapy also appeared associated with shorter OS (HR = 2.03; 95% CI, 1.02-4.24), as well as a reduced 5-year OS rate (64% vs. 86%). Those with post-radiotherapy skeletal muscle depletion also demonstrated an increased risk for locoregional recurrence (HR = 3; 95% CI, 1.18-7.6).
Weight loss of more than 5% appeared associated with a trend toward improved survival (HR = 0.48; 95%CI, 0.21-1.28); however, weight loss without skeletal muscle depletion did not influence survival.
Higher BMI appeared associated with improved survival (HR per 1-U increase = 0.91; 95% CI, 0.87-0.96). When researchers stratified outcomes by BMI, overweight (HR = 0.42; 95% CI, 0.24-0.73) and obese (HR = 0.3; 95% CI, 0.15-0.55) patients achieved longer OS than normal weight patients.
Multivariate analysis showed pre- and postradiotherapy skeletal muscle depletion, as well as baseline BMI, each were significantly associated with OS.
The researchers acknowledged the study was limited by the heterogeneous patient population — which precludes overgeneralization of results — as well as varying intervals between pre- and postradiotherapy imaging. They also noted abdominal CT imaging is not routinely performed in patients with HNSCC.
“Skeletal muscle mass and BMI each demonstrate increased prognostic value compared with weight loss and, therefore, may more accurately distinguish patients who benefit from nutritional supplementation,” Grossberg and colleagues wrote. “Our data suggest BMI or skeletal muscle mass can be used to stratify patients with HNSCC undergoing curative radiotherapy by risk, but this should be confirmed in prospective trials.” – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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