Low skeletal muscle mass as predictor of postoperative complications and decreased overall survival in locally advanced
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HEAD AND NECK
Low skeletal muscle mass as predictor of postoperative complications and decreased overall survival in locally advanced head and neck squamous cell carcinoma: the role of ultrasound of rectus femoris muscle Andrea Galli1 · Michele Colombo2 · Giulia Carrara3 · Francesca Lira Luce1 · Pier Luigi Paesano2 · Leone Giordano1 · Stefano Bondi1 · Michele Tulli1 · Aurora Mirabile4 · Francesco De Cobelli2 · Mario Bussi1 Received: 12 January 2020 / Accepted: 9 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Skeletal muscle mass (SMM) depletion and sarcopenia as predictors of postoperative complications and poorer overall survival (OS) have been validated in many surgical fields through cross-sectional imaging (CT, MRI), with potential limitations. We evaluated it in a stage III–IV head and neck squamous cell carcinoma (HNSCC) surgical cohort through ultrasound (US) of rectus femoris muscle (RF), a quick, cheap, repeatable alternative. Methods Patients submitted to surgical treatment with curative purpose were recruited and prospectively evaluated through clinical, biometric, biochemical, surgical, pathological and functional prognosticators and with preoperative US of RF with regards to 30-day complications and OS. Results Forty-seven patients completed the study. RF cross-sectional area (RF-CSA) was used to identify patients with low SMM (CSA ≤ 0.97 cm2: 18/47, 38.3%). RF-CSA was lower in complicated cases (0.95 ± 0.48 vs 1.41 ± 0.49 cm2; p = 0.003), remaining the only independent predictor of postoperative complications at multivariate analysis, with a model including ASA score and modified Frailty index (OR 9.84; p = 0.004). SMM depletion significantly impaired OS (13.6 ± 2.9 vs 26.3 ± 2.1 months; p = 0.017), being its only independent prognosticator at multivariate Cox regression analysis (OR 4.42; p = 0.033). Conclusion RF-CSA, evaluated with US, seems a reliable method for identification of patients with low SMM in a stage III–IV HNSCC cohort, defining a subset at high-risk of 30-day complications and poorer OS. Keywords Sarcopenia · Ultrasound · Rectus femoris · Head and neck cancer · Complications · Overall survival
Introduction
* Andrea Galli [email protected] 1
Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
2
Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
3
Department of General Surgery, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
4
Department of Medical Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
Worldwide, over 500,000 new cases of head and neck squamous cell carcinoma (HNSCC) are reported annually [1]. At initial presentation, about 60% of patients are diagnosed at a locally advanced stage [2]. In clinical practice, not only the extension of disease has a well-recognized influence on prognosis, but also patient age, comorbidity an
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