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Low skeletal muscle mass as predictor of postoperative complications and decreased overall survival in locally advanced head and neck squamous cell carcinoma: the role of ultrasound of rectus femoris muscle

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Skeletal muscle mass (SMM) depletion and sarcopenia as predictors of postoperative complications and poorer overall survival (OS) have been validated in many surgical fields through cross-sectional imaging (CT, MRI), with potential limitations. We evaluated it in a stage III–IV head and neck squamous cell carcinoma (HNSCC) surgical cohort through ultrasound (US) of rectus femoris muscle (RF), a quick, cheap, repeatable alternative.

Methods

Patients submitted to surgical treatment with curative purpose were recruited and prospectively evaluated through clinical, biometric, biochemical, surgical, pathological and functional prognosticators and with preoperative US of RF with regards to 30-day complications and OS.

Results

Forty-seven patients completed the study. RF cross-sectional area (RF-CSA) was used to identify patients with low SMM (CSA ≤ 0.97 cm2: 18/47, 38.3%). RF-CSA was lower in complicated cases (0.95 ± 0.48 vs 1.41 ± 0.49 cm2; p = 0.003), remaining the only independent predictor of postoperative complications at multivariate analysis, with a model including ASA score and modified Frailty index (OR 9.84; p = 0.004). SMM depletion significantly impaired OS (13.6 ± 2.9 vs 26.3 ± 2.1 months; p = 0.017), being its only independent prognosticator at multivariate Cox regression analysis (OR 4.42; p = 0.033).

Conclusion

RF-CSA, evaluated with US, seems a reliable method for identification of patients with low SMM in a stage III–IV HNSCC cohort, defining a subset at high-risk of 30-day complications and poorer OS.

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Funding

We have not received any form of financial support for the present work.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Andrea Galli, Francesca Lira Luce, Leone Giordano, Stefano Bondi, Michele Tulli & Mario Bussi

  2. Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Michele Colombo, Pier Luigi Paesano & Francesco De Cobelli

  3. Department of General Surgery, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy

    Giulia Carrara

  4. Department of Medical Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Aurora Mirabile

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  1. Andrea Galli
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Correspondence to Andrea Galli.

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Research involving human participants and/or animals

All performed procedures and retrospective data management were in accordance with the ethical standards of our institutional and national research ethical committee and with the principles stated in the Declaration of Helsinki “Ethical Principles for Medical Research Involving ‘Human Subjects”, adopted by the 18th World Medical Assembly (Helsinki, Finland, June 1964), and as amended most recently by the 64th World Medical Assembly (Fortaleza, Brazil, October 2013).

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Galli, A., Colombo, M., Carrara, G. et al. Low skeletal muscle mass as predictor of postoperative complications and decreased overall survival in locally advanced head and neck squamous cell carcinoma: the role of ultrasound of rectus femoris muscle. Eur Arch Otorhinolaryngol 277, 3489–3502 (2020). https://doi.org/10.1007/s00405-020-06123-3

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