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. 2019 Nov;8(15):6604-6613.
doi: 10.1002/cam4.2538. Epub 2019 Sep 13.

Severe muscle loss during radical chemoradiotherapy for non-metastatic nasopharyngeal carcinoma predicts poor survival

Xiao Huang  1 , Jie Ma  2 , Ling Li  1 , Xiao-Dong Zhu  1
Affiliations

Severe muscle loss during radical chemoradiotherapy for non-metastatic nasopharyngeal carcinoma predicts poor survival

Xiao Huang et al. Cancer Med. 2019 Nov.

Abstract

Background: Skeletal muscle loss is a novel imaging biomarker that is considered to be predictive of survival outcomes and toxicity in a variety of solid tumors. This study explored to investigate whether skeletal muscle loss after chemoradiotherapy (CRT) in nasopharyngeal carcinoma (NPC) patients can predict survival.

Methods: A total of 394 non-metastatic NPC patients were enrolled. The cross-sectional area of the third lumbar skeletal muscle based on computed tomography (CT) scan was measured and the skeletal muscle index (SMI) was calculated. A cut-off value suitable for the Chinese population was used to define sarcopenia, and relative changes in skeletal muscle after treatment were analyzed for the confirmation of skeletal muscle tissue loss during treatment and its impact on overall survival (OS).

Results: The median follow-up was 22.7 (range, 2.5-46.4) months. One hundred and thirty patients (33.0%) were defined sarcopenia at baseline. Two hundred and forty one patients (61.2%) had posttreatment sarcopenia. The mean SMI before and after treatment was 42.8 and 38.1 cm2 /m2 (P < .001), and the average SMA loss was 13.1 cm2 . While sarcopenia before or after treatment was not associated with OS, severe muscle loss after CRT was an independent predictor of survival prognosis for NPC (hazard ratio 2.79, 95% confidence interval 1.47-5.28, P = .002) when adjusted for gender and cancer stage.

Conclusions: During CRT, patients with NPC often experience different levels of muscle loss, and severe skeletal muscle loss may shorten OS.

Keywords: chemoradiotherapy; nasopharyngeal carcinoma; sarcopenia; skeletal muscle loss; survival.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Exclusion process for admitted patients. Initially, a total of 623 patients underwent radical chemoradiotherapy. One hundred and forty three cases were excluded due to lack of second computed tomography (CT) data. Another 85 cases were excluded due to unknown staging. One patient was excluded because of incomplete radiotherapy
Figure 2
Figure 2
The waterfall plot shows the distribution of muscle change rate after chemoradiotherapy in all patients compared to baseline
Figure 3
Figure 3
(A, B) respectively show the difference of skeletal muscle reduction area and rate in different periods of second computed tomography scan. The bold lines represent the median, while the upper and lower thin lines represent upper quartile (Q3) and lower quartile (Q1), respectively. * P < .05, *** P < .001
Figure 4
Figure 4
Kaplan‐Meier curve demonstrating overall survival according to skeletal muscle change groups for mild‐to‐moderate muscle loss (MML) and severe muscle loss (SML) patients (log‐rank test, χ 2 = 12.07, P = .0005)
Figure 5
Figure 5
Stratified analysis for gender, T stage and cancer stage. As is shown in the figure, those patients with severe muscle loss (SML) during treatment have lower overall survival (OS) than the ones with mild‐to‐moderate muscle loss (MML) except for female. A and B respectively describe men and women; C and D respectively describe T1‐2 and T3‐4; E and F describe stages I‐II and III‐IV, respectively
See this image and copyright information in PMC

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