Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients and Study Design
2.2. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Patients
3.2. Thirty-Day Postoperative Complications
3.3. Survival Analysis
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 = 592) | Sarcopenia (n = 318) | Nonsarcopenia (n = 274) | p |
---|---|---|---|---|
Age, years, n (%) | ||||
Mean (SD) | 54.2 (11) | 56.8 (12) | 51.3 (8) | <0.001 |
<65 | 522 (88.2) | 256 (80.5) | 266 (97) | <0.001 |
≥65 | 70 (11.8) | 62 (19.5) | 8 (3) | |
Sex, n (%) | ||||
Female | 74 (12.5) | 46 (14.5) | 28 (10.2) | 0.119 |
Male | 518 (87.5) | 272 (85.5) | 246 (89.8) | |
Alcohol, n (%) | ||||
Never | 152 (25.7) | 74 (23.3) | 78 (28.5) | 0.120 |
Former | 349 (59) | 197 (61.9) | 152 (55.4) | |
Current | 91 (15.3) | 47 (14.8) | 44 (16.1) | |
Smoking, n (%) | ||||
Never | 125 (21.1) | 68 (21.4) | 57 (20.8) | 0.879 |
Former | 396 (66.9) | 216 (67.9) | 180 (65.7) | |
Current | 71 (12) | 34 (10.7) | 37 (13.5) | |
Betel nut, n (%) | ||||
Never | 120 (20.3) | 64 (20.1) | 56 (20.4) | 0.863 |
Former | 319 (53.9) | 175 (55) | 144 (52.6) | |
Current | 153 (25.8) | 79 (24.9) | 74 (27) | |
CCI, n (%) | ||||
<5 | 211 (35.6) | 93 (29.2) | 118 (43.1) | <0.001 |
≥5 | 381 (64.4) | 225 (70.8) | 156 (56.9) | |
mFI-5 | ||||
0 | 310 (52.4) | 177 (55.7) | 133 (48.5) | 0.171 |
1 | 172 (29.0) | 89 (28.0) | 83 (30.3) | |
≥2 | 110 (18.6) | 52 (16.3) | 58 (21.2) | |
Cancer site, n (%) | ||||
Buccal mucosa | 227 (38.4) | 126 (39.6) | 101 (36.9) | 0.722 |
Lower gum | 158 (26.7) | 81 (25.5) | 77 (28.1) | |
Tongue | 64 (10.8) | 37 (11.6) | 27 (9.9) | |
Lower lip | 44 (7.4) | 19 (6.0) | 25 (9.1) | |
Other sites | 99 (16.7) | 55 (17.3) | 44 (16.0) | |
Pathologic stage, n (%) | ||||
1 | 196 (33.1) | 91 (28.6) | 105 (38.3) | 0.033 |
2 | 138 (23.3) | 76 (23.9) | 62 (22.6) | |
3 | 39 (6.6) | 21 (6.6) | 18 (6.6) | |
4 | 219 (37.0) | 130 (40.9) | 89 (32.5) | |
PNI, n (%) | ||||
Negative | 392 (66.2) | 207 (65.1) | 185 (67.5) | 0.451 |
Positive | 200 (33.8) | 111 (34.9) | 89 (32.5) | |
LVI, n (%) | ||||
Negative | 379 (64) | 198 (62.3) | 181 (66.1) | 0.338 |
Positive | 213 (36) | 120 (37.7) | 93 (33.9) | |
ECS, n (%) | ||||
Negative | 528 (89.2) | 279 (87.7) | 249 (90.9) | 0.206 |
Positive | 64 (10.8) | 39 (12.3) | 25 (9.1) | |
BMI, kg/m2, n (%) | ||||
Mean (SD) | 25.3 (4.3) | 24.8 (3.0) | 26.9 (4.2) | <0.001 |
<18.5 | 32 (5.4) | 6 (1.9) | 26 (9.5) | <0.001 |
18.5–22.9 | 152 (25.6) | 141 (44.3) | 11 (4) | |
23–24.9 | 130 (22) | 94 (29.6) | 36 (13.1) | |
≥25 | 278 (47) | 77 (24.2) | 201 (73.4) | |
Albumin, g/dL, n (%) | ||||
Mean (SD) | 3.5 (0.6) | 3.4 (0.6) | 3.5(0.6) | 0.052 |
≥3.5 | 232 (77.3) | 114 (70.8) | 118 (84.8) | 0.613 |
<3.4 | 68 (22.7) | 47 (29.2) | 21 (15.2) | |
Neck dissection, n (%) | ||||
No | 291 (49.2) | 151 (47.5) | 140 (51.1) | 0.381 |
Yes | 301 (50.8) | 167 (52.5) | 134 (48.9) | |
Free-tissue transfer, n (%) | ||||
No | 295 (49.8) | 157 (49.4) | 138 (50.4) | 0.809 |
Yes | 297 (50.2) | 161 (50.6) | 136 (49.6) | |
Treatment type, n (%) | ||||
Surgery only | 282 (47.6) | 155 (48.7) | 127 (46.4) | 0.623 |
Adjuvant chemo/RT | 310 (52.4) | 163 (51.3) | 147 (53.6) |
Grade | Definition | Total (n = 592) | Sarcopenia (n = 318) | Nonsarcopenia (n = 274) |
---|---|---|---|---|
Buzby classification (local complications) | ||||
I | Redness, swelling, wound not opened | 118 (19.9) | 54 (16.9) | 64 (23.4) |
II | As grade I, but wound opened, dehiscence | 129 (21.8) | 71 (22.3) | 58 (21.2) |
III | Pus visible in wound | 129 (21.8) | 82 (25.8) | 47 (17.2) |
IV | Fasciitis with surgical debridement | 16 (2.7) | 10 (3.1) | 6 (2.2) |
Dindo classification (local and systemic complications) | ||||
I | Any deviation from the normal postoperative course without the need | 116 (19.6) | 57 (17.9) | 59 (21.5) |
II | Requiring pharmacological treatment | 156 (26.4) | 81 (25.5) | 75 (27.4) |
III | Requiring surgical, endoscopic, or radiological intervention | 86 (14.5) | 61 (19.1) | 25 (9.1) |
IV | Life-threatening complication requiring intensive care management | 34 (5.7) | 18 (5.6) | 16 (5.8) |
V | Death of patient | 0 (0) | 0 (0) | 0 (0) |
Causes | Total (n = 89) | Sarcopenia (n = 48) | Nonsarcopenia (n = 41) |
---|---|---|---|
Reconstructed flap complications | 26 (29.2) | 12 (25.0) | 14 (34.1) |
Wound infection | 25 (28.0) | 16 (33.4) | 9 (22.0) |
Necrosis | 16 (18.0) | 7 (14.6) | 9 (22.0) |
Bleeding | 7 (7.9) | 4 (8.3) | 3 (7.3) |
Flap donor site complications | 8 (9.0) | 5 (10.4) | 3 (7.3) |
Wound adhesion | 7 (7.9) | 4 (8.3) | 3 (7.3) |
Characteristic | Buzby Classification | Dindo Classification | Reoperation | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | |||||||||||||
HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | HR | 95% CI | p | |
Age (<65 vs. ≥65) | 1.00 | 0.56–1.80 | 0.338 | 1.10 | 0.59–2.03 | 0.543 | 0.82 | 0.39–1.73 | 0.835 | |||||||||
Pathologic stage (1–2 vs. 3–4) | 1.79 | 1.10–2.90 | 0.048 | 1.40 | 0.93–2.10 | 0.599 | 2.10 | 1.39–3.15 | <0.001 | 1.69 | 1.04–2.48 | 0.009 | 2.12 | 1.34–3.36 | 0.002 | 1.58 | 1.00–2.47 | 0.009 |
PNI (negative vs. positive) | 1.15 | 1.03–2.23 | 0.032 | 1.11 | 0.72–1.73 | 0.788 | 1.60 | 1.06–2.42 | 0.012 | 1.04 | 0.64–1.68 | 0.641 | 1.56 | 0.99–2.48 | 0.051 | |||
LVI (negative vs. positive) | 1.35 | 0.92–1.99 | 0.114 | 1.47 | 0.98–2.42 | 0.052 | 1.31 | 0.83–2.08 | 0.059 | |||||||||
ECS (negative vs. positive) | 1.31 | 0.73–2.36 | 0.092 | 1.89 | 1.05–2.22 | 0.001 | 1.33 | 0.71–2.48 | 0.089 | 1.42 | 0.72–2.79 | 0.089 | ||||||
CCI (<5 vs. ≥5) | 0.62 | 0.38–1.01 | 0.051 | 0.94 | 0.62–1.43 | 0.262 | 0.98 | 0.61–1.57 | 0.619 | |||||||||
mFI-5 (0 vs. 1 vs. ≥2) | – | – | 0.113 | – | – | 0.923 | – | – | 0.494 | |||||||||
Albumin (≥3.5 vs. <3..4) | 0.83 | 0.48–1.45 | 0.637 | 0.77 | 0.43–1.35 | 0.155 | 0.40 | 0.16–1.00 | 0.184 | |||||||||
BMI (18.5–22.9 vs. <18.5 vs. 23–24.9 vs. ≥25) | – | – | 0.730 | – | – | 0.214 | – | – | 0.186 | |||||||||
Sarcopenia (no vs. yes) | 1.74 | 1.07–2.83 | 0.049 | 1.64 | 1.10–2.42 | 0.041 | 1.57 | 1.04–2.37 | <0.001 | 1.82 | 1.18–2.80 | 0.001 | 1.86 | 1.20–2.89 | 0.041 | 1.75 | 1.12–2.74 | 0.044 |
NLR (≤3.7 vs. >3.7) | 1.81 | 1.22–2.69 | 0.008 | 1.25 | 0.80–1.97 | 0.434 | 1.78 | 1.71–2.71 | 0.041 | 1.07 | 0.65–1.76 | 0.449 | 1.04 | 0.68–1.59 | 0.835 | |||
PLR (≤145 vs. >145) | 2.16 | 1.43–3.26 | 0.003 | 1.36 | 0.75–2.45 | 0.742 | 2.22 | 1.42–3.47 | 0.029 | 1.25 | 0.66–2.40 | 0.663 | 1.54 | 1.00–2.36 | 0.050 | |||
SII (≤459 vs. >459) | 2.23 | 1.47–3.41 | <0.001 | 2.15 | 1.40–3.30 | <0.001 | 2.37 | 1.49–3.76 | 0.005 | 1.87 | 1.14–3.04 | 0.042 | 2.38 | 1.40–4.04 | 0.004 | 1.88 | 1.13–3.13 | 0.012 |
Parameter | 5-Year | 8-Year | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Overall Survival | Disease Free Survival | Overall Survival | Disease Free Survival | |||||||||
NLR | PLR | SII | NLR | PLR | SII | NLR | PLR | SII | NLR | PLR | SII | |
AUC | 0.630 | 0.636 | 0.617 | 0.576 | 0.571 | 0.555 | 0.675 | 0.666 | 0.772 | 0.623 | 0.604 | 0.589 |
Optimal sensitivity (%) | 55.1 | 59.8 | 46.2 | 66.0 | 39.8 | 79.0 | 60.0 | 77.6 | 66.8 | 67.0 | 63.0 | 74.0 |
Optimal specificity (%) | 63.5 | 64.4 | 75.1 | 47.0 | 73.5 | 31.0 | 69.0 | 48.0 | 50.0 | 52.0 | 53.0 | 39.0 |
Cutoff value | 3.26 | 148.90 | 337.10 | 4.06 | 171.50 | 348.33 | 3.28 | 150.80 | 337.10 | 4.74 | 171.50 | 360.29 |
Characteristic | 5-Year OS | 5-Year DFS | 8-Year OS | 8-Year DFS | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | |||||
p | HR (95% CI) | p | p | HR (95% CI) | p | p | HR (95% CI) | p | p | HR (95% CI) | p | |
Age (<65 vs. ≥65) | 0.207 | 0.202 | 0.129 | 0.109 | ||||||||
Pathologic stage (1–2 vs. 3–4) | <0.001 | 1.88 (1.27–2.79) | 0.004 | <0.001 | 1.42 (1.10–1.83) | 0.032 | <0.001 | 1.93 (1.37–2.71) | 0.001 | <0.001 | 1.44 (1.15–1.89) | 0.002 |
PNI (negative vs. positive) | <0.001 | 1.67 (1.14–2.43) | 0.004 | 0.005 | 1.21 (0.91–1.61) | 0.266 | 0.001 | 1.45 (1.03–2.04) | 0.030 | 0.002 | 1.24 (0.92–1.74) | 0.161 |
LVI (negative vs. positive) | <0.001 | 1.67 (1.12–2.47) | 0.010 | <0.001 | 1.14 (0.99–2.01) | 0.052 | <0.001 | 1.54 (1.09–2.19) | 0.002 | <0.001 | 1.29 (0.97–1.03) | 0.075 |
ECS (negative vs. positive) | <0.001 | 1.80 (1.18–2.74) | 0.008 | <0.001 | 1.45 (1.04–1.75) | 0.048 | <0.001 | 1.67 (1.12–2.48) | 0.018 | <0.001 | 1.48 (1.16–2.07) | 0.033 |
CCI (<5 vs. ≥5) | 0.022 | 1.60 (1.12–2.28) | 0.008 | 0.052 | 0.064 | 0.068 | ||||||
mFI-5 (0 vs. 1 vs. ≥2) | 0.839 | 0.877 | 0.926 | 0.852 | ||||||||
Albumin (≥3.5 vs. <3.4) | 0.747 | 0.934 | 0.590 | 0.634 | ||||||||
BMI (18.5–22.9 vs. <18.5 vs. 23–24.9 vs. ≥25) | 0.025 | – | 0.560 | 0.009 | – | 0.173 | 0.047 | – | 0.561 | 0.046 | – | 0.473 |
Sarcopenia (no vs. yes) | 0.001 | 1.52 (1.08–2.13) | 0.012 | 0.004 | 1.31 (1.32–1.60) | 0.020 | <0.001 | 1.76 (1.30–2.39) | 0.001 | 0.001 | 1.42 (1.14–1.78) | 0.003 |
NLR (low vs. high) | 0.001 | 1.06 (0.69–1.63) | 0.054 | 0.005 | 1.23 (0.96–1.58) | 0.054 | <0.001 | 1.10 (0.72–1.68) | 0.079 | 0.174 | ||
PLR (low vs. high) | <0.001 | 1.39 (0.98–1.96) | 0.562 | 0.057 | 0.002 | 0.99 (0.63–1.55) | 0.310 | 0.043 | 1.01 (0.80–1.29) | 0.913 | ||
SII (low vs. high) | <0.001 | 1.20 (0.72–2.00) | 0.896 | 0.005 | 0.94 (0.66–1.33) | 0.912 | <0.001 | 1.39 (1.02–1.91) | 0.013 | 0.148 |
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Huang, C.-H.; Lue, K.-H.; Chen, P.-R.; Hsieh, T.-C.; Chou, Y.-F. Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery. Cancers 2022, 14, 785. https://doi.org/10.3390/cancers14030785
Huang C-H, Lue K-H, Chen P-R, Hsieh T-C, Chou Y-F. Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery. Cancers. 2022; 14(3):785. https://doi.org/10.3390/cancers14030785
Chicago/Turabian StyleHuang, Chun-Hou, Kun-Han Lue, Peir-Rorg Chen, Tsung-Cheng Hsieh, and Yu-Fu Chou. 2022. "Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery" Cancers 14, no. 3: 785. https://doi.org/10.3390/cancers14030785