Withdrawn 33rd Lorne Cancer Conference 2021

Post-treatment sarcopenia and myosteatosis as risk factors for decreased long-term survival in patients with head and neck cancer undergoing curative-intent treatment (73317)

Elizabeth Ahern 1 2 , Teresa Brown 3 4 , Louise Campbell 5 , Brett Hughes 6 7 , Merrilyn D Banks 4 , Charles Y Lin 7 8 , Lizbeth M Kenny 7 8 , Judy D Bauer 3
  1. Monash Health, Clayton, VICTORIA, Australia
  2. School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  3. Centre for Dietetics Research (C-DIET-R), University of Queensland, St Lucia, Queensland, Australia
  4. Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  5. Department of Nuclear Medicine and Specialised PET Services Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  6. Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  7. School of Medicine, University of Queensland, Herston, Queensland, Australia
  8. Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia

Background: Malnutrition, including sarcopenia, is prevalent in patients with head and neck cancer. The relationship between pre-treatment sarcopenia and adverse oncologic outcomes in this population is well described, although the impact of myosteatosis and post-treatment sarcopenia is less well characterised.

Methods: 125 patients with head and neck squamous cell carcinoma (HNSCC) and prophylactic gastrostomy undergoing curative-intent therapy containing radiotherapy (RT) were assessed for evidence of sarcopenia and myosteatosis, using cross-sectional FDG-PET/CT imaging at the level of L3 vertebra. Sarcopenia was defined as radiologically-assessed muscularity less than the fifth percentile according to gender. Myosteatosis was assessed through calculation of mean muscle attenuation. Assessments were completed at baseline (pre-treatment) and approximately three months post-treatment and associated with progression-free and overall survival (OS) at 12 months and five years post-treatment completion.

Results: 101 participants had a CT scan evaluable at one or two timepoints, of which 67 (66%) participants were sarcopenic on at least one timepoint. Increasing age was significantly associated with risk of sarcopenia (OR 1.09, 95% CI 1.04-1.15). 93%-97% patients had myosteatosis. Changes during treatment in body mass index (BMI) and weight were not different when comparing those with or without sarcopenia or myosteatosis pre-treatment. 5-year OS was significantly worse in those with post-treatment sarcopenia (HR 0.37, 95% CI 0.16-0.88) and those with post-treatment myosteatosis who were also sarcopenic (compared with not sarcopenic) (HR 0.33, 95% CI 0.13-0.83).

Conclusion: Rates of myosteatosis were high at both pre- and post-treatment timepoints. Body mass index and percentage weight loss does not differentiate those with or without sarcopenia or myosteatosis. Post-treatment sarcopenia was significantly associated with worse five-year overall survival, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be further evaluated as a novel independent risk factor for decreased long-term survival post-treatment containing RT for HNSCC. Myosteatosis, whilst being highly prevalent, does not seem to enrich survival prediction. Interventions targeting sarcopenia should be developed and tested.