Sarcopenia is associated with higher toxicity and poor prognosis of nasopharyngeal carcinoma

Xin Hua; Jun-Fang Liao; Xin Huang; Han-Ying Huang; Wen Wen; Zhi-Qing Long; Ling Guo; Zhong-Yu Yuan; Huan-Xin Lin

doi:10.1177/1758835920947612

Sarcopenia is associated with higher toxicity and poor prognosis of nasopharyngeal carcinoma

Ther Adv Med Oncol. 2020 Aug 18:12:1758835920947612. doi: 10.1177/1758835920947612. eCollection 2020.

Authors

Xin Hua¹, Jun-Fang Liao², Xin Huang¹, Han-Ying Huang¹, Wen Wen¹, Zhi-Qing Long¹, Ling Guo³, Zhong-Yu Yuan⁴, Huan-Xin Lin⁵

Affiliations

¹ SunYat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, China.
² Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
³ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P. R. China.
⁴ Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P. R. China.
⁵ Department of Radiotherapy, SunYat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P. R. China.

Abstract

Background: Given the growing evidence that sarcopenia is associated with toxicity and survival in various cancers, we investigated its significance in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT).

Methods: In this retrospective analysis, we studied 862 NPC patients who had received CCRT between 2010 and 2014. Sarcopenia was determined using routine pre-radiotherapy computed tomography (CT) simulation scans at the third cervical vertebral level. Receiver-operating characteristic curve analyses were used to determine the optimal cutoff values. Propensity score matching (PSM) was applied to develop comparable cohorts of patients with or without sarcopenia.

Results: A total of 862 patients were included as the primary cohort, and 308 patients were matched and regarded as the matched cohort. In the primary cohort, the 5-year overall survival (OS), locoregional recurrence-free survival, and distant metastasis-free survival (DMFS) rates for the sarcopenia group versus non-sarcopenia group were 78.2% versus 93.6% (p < 0.001), 89.4% versus 87.9% (p = 0.918), and 82.5% versus 89.0% (p = 0.007), respectively. Univariate and multivariate survival analyses revealed that sarcopenia was an independent predictor of OS (p < 0.001 and p < 0.001) and DMFS (p = 0.009, p = 0.034). Patients with sarcopenia experienced significantly higher rates of treatment-related toxicities compared with patients without sarcopenia (p = 0.032). In addition, patients with sarcopenia also experienced significantly worse treatment response than those without sarcopenia (p = 0.004). Similar results were found in a PSM cohort.

Conclusion: The current findings support that sarcopenia is a promising indicator for predicting clinical outcomes in NPC patients receiving CCRT. A simple and rapid analysis on CT simulation images can provide information about the therapeutic toxicity and survival prognosis, consequently guiding personalized multi-modality interventions during CCRT.

Keywords: concurrent chemoradiotherapy; nasopharyngeal carcinoma; sarcopenia; survival; toxicity; treatment response.