Dados do Trabalho

Título

Low Muscularity impacts survival in patients with metastatic or recurrent head and neck cancer

Introdução/Justificativa

The prognosis of patients with head and neck cancer (HNC) is determined by factors extrinsic and intrinsic to the patient and the disease, such as age, smoking, alcoholism, HPV infection, tumor staging, and performance status and facts involving low muscularity, which is an independent adverse prognostic factor in some types of cancer, such as HNC. However, the impact of muscularity in the scenario of metastatic or recurrent HNC (mHNC) patients has still been little explored, especially when evaluated at the level of the third cervical vertebra (C3).

Objetivos

To evaluate the impact of muscularity on the overall survival (OS) of patients with mHNC.

Materiais e Métodos

Retrospective and analytical study carried out at the Hospital de Clínicas of the University of Campinas (HC-UNICAMP). Patients diagnosed with mHNC during the period from January 2010 to December 2018 were included. Demographic and clinical data were collected from information in the medical record. The computed tomography images were used to evaluate the area of muscle tissue at the C3 level (cm²), calculated with Software SliceOMatic V.5.0. Muscularity was calculated after converting the muscular cross-sectional area (CSA) at C3 to the CSA at L3. Fisher's exact test was applied to investigate the difference between groups, the Kaplan-Meier method was used to construct survival curves. The Cox Proportional Hazard Model was used to investigate the association of muscularity with OS. Model was adjusted for age (categorical) and ECOG (categorical). This study was approved by the Institutional Review Board (CAAE: 42743120.5.0000.5404).

Resultados

The study population consisted of 101 adult and elderly patients of both sexes diagnosed with mHNC, 79 of which were classified as having normal muscularity (NM) and 22 with low muscularity (LM). The LM group had a higher proportion of individuals aged over 70 years and with a body mass index less than 18.5. They also had lower total adipose tissue area (mean; NM= 22,4 cm2; LM=10,3 cm2; p=0,019) and total adipose tissue index (mean; NM= 8,3 cm2/m2; LM=3,7 cm2/m2; p=0,018). The LM group had a significantly worse survival rate (HR=1.73; 95% CI 1.02-2.92) when compared to the NM group. The median survival was 4.4 months for the LM group and 8.4 months for the NM group. The LM group also had lower adiposity (p=0.018).

Conclusão

Low muscularity impacts the mortality of patients with HNCm independent of age and ECOG.

Palavras Chave

body composition; oncology; prognosis.