Clinical analysis on sarcopenia according to the site of head and neck cancer

In cases of cancer patients with sarcopenia, many adverse effects such as postoperative complications and prognosis have been reported with head and neck cancer. We examined the prevalence and prognosis of sarcopenia according to the site in head and neck cancer in order to clarify the site that require early intervention as the primary endpoints.

From October 2016 to March 2021, we retrospectively studied 388 cases of 448 primary cases of head and neck cancer who visited our department and for whom measurement using bioelectrical impedance analysis (BIA) and grip strength were possible. 339 cases that had undergone radical treatment were retrospectively examined.

Of the 388 primary cases of head and neck cancer, 102 patients were diagnosed with sarcopenia. The most common site is oral cancer, followed by oropharyngeal cancer, and hypopharyngeal cancer. In terms of the patient background, sarcopenia was significantly more common in patients aged "65 years or older," in those in "stage III or higher, in those in "T3 or higher," in those with a history of drinking alcohol and in those with "site-related swallowing (oral cavity, oropharynx, and hypopharynx)". The prevalence of sarcopenia in terms of stage classification was 25% or more in advanced cancer cases for all sites of head and neck cancers; however, it was observed from stage I or higher for oropharyngeal cancer and stage II or higher for hypopharyngeal cancer. The 3-year overall survival rate for oral cancer, oropharyngeal cancer, and hypopharyngeal cancer was significantly worse in sarcopenic patients than in non-sarcopenic patients; however, for laryngeal cancer and other cancers, while the 3-year overall survival rate was worse in sarcopenic patients than in non-sarcopenic patients, no significant difference was observed.

In cases of head and neck cancer, elderly patients and those with oral, oropharyngeal, or hypopharyngeal cancers, which are closely related to swallowing, tend to be more susceptible to sarcopenia. As prognosis of these sites is also affected by sarcopenia, careful attention should be paid to the presence or absence of sarcopenia. In particular, because patients with oropharyngeal cancer and/or hypopharyngeal cancer are prone to sarcopenia from an early stage, the presence or absence of sarcopenia should be confirmed in the event a suspected lesion is observed in the oropharynx and/or hypopharynx.