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Temporal muscle thickness is associated with immunotherapy outcomes in head and neck squamous cell carcinoma
Hirotaka Eguchi1, Kiyohito Hosokawa1, Ryota Kawano1
1Department of Otorhinolaryngology-Head and Neck Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Background:
Reduced skeletal muscle mass may impair outcomes of immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma. We evaluated whether temporal muscle thickness (TMT) on routine head computed tomography was associated with treatment response and survival.
Methods:
We retrospectively analyzed 109 patients treated with nivolumab or pembrolizumab between 2017 and 2023 (89 men [81.7%], 20 women [18.3%]; median age 69 years [range 21-88]). TMT was measured on CT images at the level where the Sylvian fissure was most clearly visualized, perpendicular to the temporalis muscle long axis, on both sides, and the mean of the bilateral values was used. Sex-specific cutoffs were defined by time-dependent receiver operating characteristic analysis for 12-month overall survival (5.53 mm for men; 3.92 mm for women). Associations with objective response and survival were assessed using logistic regression and Cox proportional hazards models.
Results:
Objective response was evaluable in 105 patients (complete response 12, partial response 30, stable disease 18, progressive disease 45), yielding a response rate of 40.0% and a disease control rate of 57.1%. High temporal muscle thickness was associated with response (univariable odds ratio 2.64, 95% confidence interval 1.18-5.90; p = 0.018) and remained significant after adjustment for chemotherapy (adjusted odds ratio 2.42, 95% confidence interval 1.05-5.58; p = 0.038). One-year progression-free survival was 36.5% in the high group versus 15.8% in the low group (absolute difference 20.7%; p = 0.010; adjusted hazard ratio 0.57, 95% confidence interval 0.36-0.90; p = 0.017). One-year overall survival was 73.1% versus 47.4% (absolute difference 25.7%; p = 0.001; adjusted hazard ratio 0.54, 95% confidence interval 0.34-0.86; p = 0.010).
Conclusion:
Temporal muscle thickness, obtainable from routine head computed tomography, was independently associated with response and survival in patients receiving immune checkpoint inhibitors and may serve as a practical host-related imaging marker for prognostic risk stratification.
Insights
Increased temporal muscle thickness (TMT) on CT scans is linked to better outcomes for head and neck cancer patients receiving immune checkpoint inhibitors. This simple measurement can help predict treatment response and survival.
Area of Science:
- Oncology
- Radiology
- Immunotherapy
Background:
- Skeletal muscle mass is crucial for outcomes in patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoint inhibitors (ICIs).
- Temporal muscle thickness (TMT) measured on routine head computed tomography (CT) scans is a potential indicator of skeletal muscle status.
Purpose of the Study:
- To evaluate the association between TMT on routine head CT scans and treatment response in patients with HNSCC receiving ICIs.
- To assess the relationship between TMT and survival outcomes in this patient population.
Main Methods:
- Retrospective analysis of 109 HNSCC patients treated with nivolumab or pembrolizumab (2017-2023).
- TMT was measured on head CT scans, with sex-specific cutoffs determined for 12-month overall survival.
- Logistic regression and Cox proportional hazards models were used to assess associations with objective response and survival.
Main Results:
- Higher TMT was significantly associated with objective response (adjusted odds ratio 2.42, p=0.038).
- Patients with high TMT showed improved one-year progression-free survival (36.5% vs 15.8%, p=0.010) and overall survival (73.1% vs 47.4%, p=0.001) compared to those with low TMT.
- TMT independently predicted response and survival, with adjusted hazard ratios of 0.57 for PFS and 0.54 for OS.
Conclusions:
- Temporal muscle thickness, easily measured from routine head CT, is an independent predictor of treatment response and survival in HNSCC patients receiving ICIs.
- TMT may serve as a practical, host-related imaging biomarker for prognostic risk stratification in this patient group.
