Clinical Significance of Sarcopenia among Patients with Advanced Oropharyngeal Cancer

• Published in: Otolaryngology-head and neck surgery 2019-03, Vol.160 (3), p.480-487
• Main Authors: Tamaki, Akina, Manzoor, Nauman F., Babajanian, Eric, Ascha, Mustafa, Rezaee, Rod, Zender, Chad A.
• Format: Article
• Language: English
• Subjects: head and neck cancer; human papillomavirus; oropharyngeal squamous cell carcinoma; sarcopenia
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599818793857

Objectives We investigated the prevalence and impact of sarcopenia on disease-free survival (DFS) and overall survival (OS) in advanced oropharyngeal cancer. Study Design Retrospective study. Setting Single-institution tertiary cancer care center. Subjects and Methods We identified patients with advanced oropharyngeal cancer with pretreatment positron emission tomography–computed tomography scans for image analysis. Data were collected on the following variables: age, sex, smoking and alcohol status, stage (TNM and American Joint Committee on Cancer), human papillomavirus (HPV) status, body mass index (BMI), and treatment modality. Results Of 113 patients identified with oropharyngeal cancer, 32 had sarcopenia: these patients were older (63.5 vs 57.6 years, P = .01), were less likely to be male (53.1% vs 76.5%, P = .03), and had a lower mean BMI (24.5 vs 28.4 kg/m2, P = .009). Eighty-five subjects had HPV-positive disease, and they had a higher BMI (28.2 vs 24.2 kg/m2, P = .01) than that of patients without HPV. Twenty-one subjects who were HPV positive had less cancer recurrence (24.7% vs 48.1%, P = .04) than that of their HPV-negative counterparts. Log-rank testing showed no difference in DFS (P = .06) associated with sarcopenia but a significant difference in OS (P = .049). There were differences in DFS (P = .009) and OS (P = .023) based on HPV status. According to univariable and multivariable models, HPV positivity exhibited improved DFS and OS. Sarcopenia was not statistically significant in survival models; however, it was associated with increased mortality and recurrence. Conclusion Sarcopenia is a prognostic factor affecting OS independent of HPV status in advanced oropharyngeal cancer.