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Sarcopenia as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis
Hongpeng Zhang1,2, Jinghong Xu3,4, Chao Chai1,2
1Department of Radiology, Medical Imaging Institute of Tianjin, First Central Hospital of Tianjin Medical University, Tianjin, China.
Objectives:
Sarcopenia is an established prognostic biomarker in malignancies, and its integration with inflammation demonstrates a synergistic amplification of adverse outcomes; its role in the prognosis of head and neck squamous cell carcinoma (HNSCC) remains inadequately characterized. The objectives of our study are to determine the prognostic value of combined sarcopenia and inflammation in HNSCC.
Materials And Methods:
A systematic search of PubMed, Web of Science, and Embase identified studies comparing survival outcomes among HNSCC patients stratified by the presence or absence of sarcopenia and concurrent inflammation. Pooled hazard ratio (pHR) and 95% confidence interval (CI) were calculated using random effect model. Heterogeneity was quantified using I² statistics, with sensitivity analyses, Graphic Display of Study Heterogeneity (GOSH) plots, and subgroup analyses to evaluate robustness and sources of heterogeneity.
Results:
26 studies (22,408 patients; mean age range from 51 to 73 years; 85.5% male) were included. Sarcopenia was associated with significantly reduced overall survival (OS: pHR = 1.89; p < 0.001) and disease-free survival (DFS: pHR = 2.01; p < 0.001). Combined sarcopenia-inflammation assessment further reduced OS (pHR = 14.56) and DFS (pHR = 5.92; both p < 0.001). Prognostic utility was comparable across vertebral levels (C3 vs. L3): OS (C3: pHR = 1.88; L3: pHR = 2.09; interaction p = 0.70) and DFS (C3: pHR = 1.75; L3: pHR = 2.43; interaction p = 0.23).
Conclusion:
Sarcopenia is independently associated with diminished survival rates in patients with HNSCC, and the additional value of inflammation synergistically exacerbates adverse clinical outcomes.
Key Points:
Question The impact of sarcopenia on head and neck squamous cell carcinoma (HNSCC) patients remains unclear, with a lack of standardized imaging diagnostic criteria. Findings HNSCC patients with sarcopenia exhibit poor prognosis, and inflammation further shortens survival, while different radiological diagnostic criteria demonstrate comparable efficacy. Clinical relevance Management of HNSCC patients should emphasize sarcopenia assessment and attention to inflammatory burden; reducing both risks may improve prognosis.
