Biochemical Markers of Sarcopenia as Predictors of Outcomes Among Patients Undergoing Laryngectomy

Sarcopenia, the systemic loss of skeletal muscle mass and function, is prevalent and particularly detrimental to head and neck cancer (HNC) patients. Cancer-associated sarcopenia involves complex mechanisms of poor nutrition and inflammation, highlighting the necessity for preoperative identification of these high-risk patients.

A multi-site retrospective chart review (2016-2021) was performed on HNC patients undergoing total laryngectomy with or without reconstruction. Preoperative lab values were utilized to calculate markers of sarcopenia including systemic immune inflammation index (SII), nutrition-related index (NRI), geriatric NRI (GNRI), and neutrophil-to-lymphocyte ratio (NLR). Comparative analyses, ROC curves, and logistic regressions were conducted to evaluate the predictive value of these indices on 30-day postoperative outcomes.

In a cohort of 520 laryngectomy patients (75.8% salvage), postoperative fistula, major complication, and prolonged PO intake > 30 days were recorded in 22.7%, 25.4%, and 26.2% of patients, respectively. NLR was higher in patients with prolonged PO intake, while the NRI/GNRI was lower in patients with delayed PO intake. There were no significant differences in patient indices with or without fistula and major complications. All nutritional indices on ROC curves had areas under the curve < 0.600. After adjusting for confounding on multivariate logistic regression, the NLR (OR = 0.95) and SII (OR = 0.98) were predictive of major postoperative complications, while the NRI/GNRI (OR = 0.96) was predictive of delayed PO intake.

Nutritional indices may be valuable to predict adverse postoperative laryngectomy outcomes. Prospective studies are needed to validate these findings.