Prospective Evaluation of Sarcopenia in Head and Neck Cancer Patients Treated with Radiotherapy or Radiochemotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients’ Characteristics
2.2. CT Scan
2.3. Statistics
3. Results
3.1. Patient Characteristics
3.2. Patient Characteristics According to Treatment
3.3. Treatment Compliance and Toxicity
3.4. Survival Endpoints
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Total (n = 243) | Radiotherapy (n = 116) | Radiochemotherapy (n = 127) | p-Value |
---|---|---|---|---|
Sex ratio (M:F) | 3.34 | 3.14 | 3.54 | 0.7 |
Age (years), mean ± SD | 61.13 ± 9.04 | 63.41 ± 10.40 | 59.04 ± 6.99 | 0.00014 |
Age (median; Q1–Q3) | 61 (56; 66) | 62.5 (57; 70) | 60 (54.5; 64) | |
Smoking history, n (%) | 0.25 | |||
Ever | 198 (81.5) | 98 (84.5) | 100 (78.7) | |
Never | 45 (18.5) | 18 (15.5) | 27 (21.3) | |
Chronic alcohol drinking, n (%) | 0.86 | |||
Yes | 118 (48.6) | 57 (49.1) | 61 (48.0) | |
No | 125 (51.4) | 59 (50.9) | 66 (52.0) | |
BMI, mean ± SD | 24.94 ± 4.56 | 24.78 ± 4.72 | 25.09 ± 4.43 | 0.59 |
Cancer site, n (%) | 0.3 | |||
Oral cavity | 69 (28.4) | 39 (33.6) | 30 (23.6) | |
Oropharynx | 79 (32.5) | 32 (27.6) | 47 (37.0) | |
Hypopharynx | 39 (16.0) | 17 (14.7) | 22 (17.3) | |
Larynx | 39 (16.0) | 21 (18.1) | 18 (14.2) | |
Cancer of unknown primary (CUP) | 17 (7.0) | 7 (6.0) | 10 (7.9) | |
T stage, n (%) | 0.0039 | |||
T0 | 17 (7.0) | 7 (6.0) | 10 (7.9) | |
T1 | 45 (18.5) | 29 (25.0) | 16 (12.6) | |
T2 | 79 (32.5) | 45 (38.8) | 34 (26.8) | |
T3 | 51 (21.0) | 18 (15.5) | 33 (26.0) | |
T4 | 51 (21.0) | 17 (14.7) | 34 (26.8) | |
N stage, n (%) | <0.0001 | |||
N0 | 91 (37.4) | 61 (52.6) | 30 (23.6) | |
N1 | 47 (19.3) | 19 (16.4) | 28 (22.0) | |
N2 | 82 (33.7) | 29 (25.0) | 53 (41.7) | |
N3 | 23 (9.5) | 7 (6.0) | 16 (12.6) | |
Stage, n (%) | <0.0001 | |||
I | 19 (7.8) | 17 (14.7) | 2 (1.6) | |
II | 50 (20.6) | 30 (25.9) | 20 (15.7) | |
III | 57 (23.5) | 26 (22.4) | 31 (24.4) | |
IV | 117 (48.1) | 43 (37.1) | 74 (58.3) | |
p16 status (among oropharyngeal cancer patients), n (%) | 0.09 | |||
Positive | 23 (29.1) | 5 (15.6) | 18 (38.3) | |
Negative | 30 (38.0) | 14 (43.8) | 16 (34.0) | |
Not known | 26 (32.9) | 13 (40.6) | 13 (27.7) | |
WHO PS, n (%) | 0.15 | |||
0 | 97 (40.1) | 41 (35.7) | 56 (44.1) | |
1 | 127 (52.5) | 62 (53.9) | 65 (51.2) | |
2 | 18 (7.4) | 12 (10.4) | 6 (4.7) | |
Undernutrition, n (%) | 0.48 | |||
Yes | 8 (3.3) | 5 (4.4) | 3 (2.4) | |
No | 231 (96.7) | 108 (95.6) | 123 (97.6) | |
Sarcopenia, n (%) | 0.12 | |||
Present | 88 (36.7) | 48 (41.7) | 40 (32.0) | |
Absent | 152 (63.3) | 67 (58.3) | 85 (68.0) | |
Performed surgery, n (%) | <0.0001 | |||
Yes | 152 (62.6) | 89 (76.7) | 63 (49.6) | |
No | 91 (37.4) | 27 (23.3) | 64 (50.4) |
Toxicities | Radiotherapy (n = 116) | p-Value * | Radiochemotherapy (n = 127) | p-Value * | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sarcopenia (n = 48) | No Sarcopenia (n = 67) | Sarcopenia (n = 40) | No Sarcopenia (n = 85) | |||||||||||
Grade 0–1 | Grade 2 | Grade ≥ 3 | Grade 0–1 | Grade 2 | Grade ≥3 | Grade 0–1 | Grade 2 | Grade ≥ 3 | Grade 0–1 | Grade 2 | Grade ≥ 3 | |||
Mucositis | 11 (22.9) | 28 (58.3) | 9 (18.8) | 14 (20.9) | 42 (62.7) | 11 (16.4) | 0.89 | 7 (17.5) | 23 (57.5) | 10 (25.0) | 18 (21.4) | 49 (58.3) | 17 (20.2) | 0.78 |
Dermatitis | 16 (33.3) | 28 (58.3) | 4 (8.3) | 27 (40.9) | 33 (50.0) | 6 (9.1) | 0.69 | 13 (32.5) | 23 (57.5) | 4 (10.0) | 34 (40.5) | 42 (50.0) | 8 (9.5) | 0.66 |
Dysphagia | 26 (56.5) | 10 (21.7) | 10 (21.7) | 31 (47.7) | 23 (35.4) | 11 (16.9) | 0.3 | 16 (40.0) | 9 (22.5) | 15 (37.5) | 31 (36.9) | 23 (27.4) | 30 (35.7) | 0.84 |
2 or 3 toxicities in one patient | 42 (87.5) | 59 (88.1) | 0.93 | 35 (87.5) | 70 (83.3) | 0.55 |
Characteristics | OS | DFS | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariable | Univariate | Multivariable | |||||||||
HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | |
Age | 1.01 | [0.98–1.04] | 0.352 | 1.02 | [0.99–1.04] | 0.193 | ||||||
BMI | 0.95 | [0.89–1] | 0.068 | 0.97 | [0.92–1.02] | 0.182 | ||||||
WHO PS 2 (vs. 0–1) | 6.15 | [3.12–12.11] | <0.001 | 4.26 | [2.08–8.73] | <0.001 | 6.87 | [3.84–12.3] | <0.001 | 4.14 | [2.19–7.84] | <0.001 |
Stage III–IV (vs. I–II) | 2.45 | [1.24–4.84] | 0.01 | 1.99 | [0.96–4.12] | 0.065 | 2.14 | [1.22–3.76] | 0.008 | 2.1 | [1.11–3.94] | 0.023 |
Tumor site | ||||||||||||
Oropharynx | 1 | |||||||||||
CUP | 0.64 | [0.19–2.13] | 0.463 | 0.76 | [0.26–2.18] | 0.605 | ||||||
Oral cavity | 0.92 | [0.47–1.77] | 0.795 | 1.36 | [0.78–2.37] | 0.282 | ||||||
Hypopharynx | 1.03 | [0.47–2.25] | 0.938 | 1.55 | [0.82–2.96] | 0.18 | ||||||
Larynx | 1.08 | [0.53–2.18] | 0.829 | 1.13 | [0.59–2.18] | 0.709 | ||||||
Undernutrition | 4.16 | [1.51–11.5] | 0.006 | 3.44 | [1.39–8.52] | 0.007 | ||||||
Surgery | 0.75 | [0.45–1.25] | 0.273 | 0.74 | [0.48–1.15] | 0.184 | 0.64 | [0.37–1.09] | 0.099 | |||
Sarcopenia | 2.52 | [1.51–4.20] | <0.001 | 1.9 | [1.11–3.25] | 0.019 | 2.45 | [1.58–3.78] | <0.001 | 1.7 | [1.06–2.71] | 0.026 |
p16 Positivity | 0.44 | [0.14–1.39] | 0.161 | 0.42 | [0.15–1.16] | 0.094 | ||||||
RTCT | 0.8 | [0.49–1.33] | 0.396 | 0.75 | [0.48–1.15] | 0.186 | 0.57 | [0.34–0.96] | 0.036 |
Characteristics/Treatment | RT | RTCT | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariable | Univariate | Multivariable | |||||||||
PFS | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p |
Age | 1.03 | [1–1.06] | 0.049 | 0.97 | [0.93–1.02] | 0.238 | 0.96 | [0.91–1] | 0.095 | |||
BMI | 0.98 | [0.92–1.05] | 0.591 | 0.95 | [0.88–1.03] | 0.201 | ||||||
WHO PS = 2 | 9.12 | [4.20–19.8] | <0.001 | 5.9 | [2.38–14.61] | <0.001 | 4.94 | [1.91–12.79] | 0.001 | 4.57 | [1.74–11.98] | 0.002 |
Stage III/IV (vs. I/II) | 1.85 | [0.99–3.49] | 0.056 | 2.27 | [1–5.14] | 0.05 | 8.84 | [1.21–64.41] | 0.032 | 7.49 | [1.02–55.13] | 0.048 |
Tumor site | ||||||||||||
Oropharynx | 1 | |||||||||||
CUP | 1.31 | [0.36–4.72] | 0.679 | 0.33 | [0.04–2.50] | 0.283 | ||||||
Oral cavity | 1.09 | [0.48–2.43] | 0.843 | 1.72 | [0.79–3.74] | 0.169 | ||||||
Hypopharynx | 2.5 | [1.03–6.08] | 0.043 | 0.99 | [0.38–2.60] | 1 | ||||||
Larynx | 1.27 | [0.52–3.06] | 0.599 | 0.92 | [0.33–2.55] | 0.872 | ||||||
Undernutrition | 3.67 | [1.13–11.9] | 0.03 | 5 | [1.37–18.32] | 0.015 | 3.21 | [0.77–13.39] | 0.109 | |||
Surgery | 0.49 | [0.26–0.94] | 0.03 | 0.29 | [0.13–0.62] | 0.001 | 0.85 | [0.45–1.61] | 0.617 | |||
Sarcopenia | 2.94 | [1.60–5.42] | <0.001 | 2.49 | [1.26–4.9] | 0.008 | 1.93 | [1.02–3.67] | 0.044 | |||
P16 Positivity | 1.02 | [0.24–4.23] | 0.98 | 5.04 | [1.08–23.64] | 0.04 | 0.29 | [0.07–1.23] | 0.093 | |||
OS | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p |
Age | 1.03 | [0.99–1.07] | 0.13 | 0.97 | [0.92–1.03] | 0.307 | 0.96 | [0.90–1.02] | 0.148 | |||
BMI | 0.97 | [0.89–1.05] | 0.404 | 0.93 | [0.85–1.02] | 0.112 | ||||||
WHO PS = 2 | 6.69 | [2.73–16.4] | <0.001 | 4.23 | [1.45–12.33] | 0.008 | 5.15 | [1.76–15.1] | 0.003 | 4.84 | [1.63–14.36] | 0.004 |
Stage III/IV (vs. I/II) | 2.12 | [0.98–4.59] | 0.057 | 2.69 | [0.94–7.67] | 0.064 | 6.58 | [0.89–48.4] | 0.064 | 5.59 | [0.75–41.65] | 0.092 |
Tumor site | ||||||||||||
oropharynx | 1 | 1 | ||||||||||
CUP | 1.33 | [0.37–4.87] | 0.664 | 0 * | ||||||||
oral cavity | 0.61 | [0.23–1.61] | 0.319 | 1.36 | [0.55–3.35] | 0.501 | ||||||
hypopharynx | 1.35 | [0.46–3.99] | 0.585 | 0.8 | [0.26–2.48] | 0.695 | ||||||
larynx | 1.03 | [0.39–2.72] | 0.947 | 1.06 | [0.37–3.01] | 0.914 | ||||||
Undernutrition | 6.24 | [1.88–20.7] | 0.003 | 12.25 | [2.93–51.15] | <0.001 | 2.18 | [0.29–16.1] | 0.445 | |||
Surgery | 0.6 | [0.28–1.31] | 0.2 | 0.4 | [0.15–1.04] | 0.06 | 0.75 | [0.36–1.57] | 0.448 | |||
Sarcopenia | 2.71 | [1.31–5.59] | 0.007 | 2.24 | [1.03–4.86] | 0.041 | 2.21 | [1.06–4.59] | 0.034 | |||
P16 Positive | 0.71 | [0.10–5.27] | 0.742 | 0.39 | [0.09–1.64] | 0.198 |
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Thureau, S.; Lebret, L.; Lequesne, J.; Cabourg, M.; Dandoy, S.; Gouley, C.; Lefebvre, L.; Mallet, R.; Mihailescu, S.-D.; Moldovan, C.; et al. Prospective Evaluation of Sarcopenia in Head and Neck Cancer Patients Treated with Radiotherapy or Radiochemotherapy. Cancers 2021, 13, 753. https://doi.org/10.3390/cancers13040753
Thureau S, Lebret L, Lequesne J, Cabourg M, Dandoy S, Gouley C, Lefebvre L, Mallet R, Mihailescu S-D, Moldovan C, et al. Prospective Evaluation of Sarcopenia in Head and Neck Cancer Patients Treated with Radiotherapy or Radiochemotherapy. Cancers. 2021; 13(4):753. https://doi.org/10.3390/cancers13040753
Chicago/Turabian StyleThureau, Sébastien, Lucie Lebret, Justine Lequesne, Marine Cabourg, Simon Dandoy, Céline Gouley, Laureline Lefebvre, Romain Mallet, Sorina-Dana Mihailescu, Cristian Moldovan, and et al. 2021. "Prospective Evaluation of Sarcopenia in Head and Neck Cancer Patients Treated with Radiotherapy or Radiochemotherapy" Cancers 13, no. 4: 753. https://doi.org/10.3390/cancers13040753