(1) Background: Sarcopenia lasting >1 year might be considered a chronic condition in many HNSCC patients. CT-scan-derived Skeletal Muscle Mass Index (SMI) is an established surrogate of sarcopenia; yet, the cut-off reported in the literature (literature-based, lb-SMI < 43.2) is mainly based on the risk of chemoradiotherapy-induced toxicity, and the optimal value to discriminate OS is under-investigated. (2) Methods: The effect on OS of the lb-SMI cutoff was compared with an untailored OS-oriented SMI cutoff obtained in a cohort of consecutive advanced HNSCC patients treated with primary chemoradiotherapy, bio-chemotherapy or chemo-immunotherapy (cohort-specific, cs-SMI cutoff). Gender- and BMI-tailored (gt-SMI and bt-SMI) cut-offs were also evaluated. Cutoff values were identified by using the maximally selected rank statistics for OS. (3) Results: In 115 HNSCC patients, the cs-SMI cutoff was 31.50, which was lower compared to the lb-SMI reported cut-off. The optimal cut-off separately determined in females, males, overweight and non-overweight patients were 46.02, 34.37, 27.32 and 34.73, respectively. gt-SMI categorization had the highest effect on survival (p< 0.0001); its prognostic value was independent of the treatment setting or the primary location and was retained in a multivariate cox-regression analysis for OS including other HNSCC-specific prognostic factors (p= 0.0004). (4) Conclusions: A tailored SMI assessment would improve clinical management of sarcopenia in chemoradiotherapy-, bio-chemotherapy- or chemo-immunotherapy-treated HNSCC patients. Gender-based SMI could be used for prognostication in HNSCC patients.
(1) 背景：在众多头颈部鳞状细胞癌患者中，持续超过一年的肌肉减少症可被视为慢性病症。基于CT扫描的骨骼肌质量指数是评估肌肉减少症的公认替代指标；然而，文献中报道的临界值（基于文献的lb-SMI < 43.2）主要依据放化疗所致毒性的风险确定，而用于区分总生存期的最佳临界值尚未得到充分研究。(2) 方法：本研究将lb-SMI临界值对总生存期的影响，与在一组接受根治性放化疗、生物化疗或化学免疫治疗的连续晚期头颈部鳞状细胞癌患者队列中获得的、未经调整的以总生存期为导向的SMI临界值（队列特异性cs-SMI临界值）进行比较。同时评估了基于性别和体重指数调整的临界值（gt-SMI和bt-SMI）。所有临界值均通过使用针对总生存期的最大选择秩统计法确定。(3) 结果：在115例头颈部鳞状细胞癌患者中，cs-SMI临界值为31.50，低于文献报道的lb-SMI临界值。在女性、男性、超重和非超重患者中分别确定的最佳临界值分别为46.02、34.37、27.32和34.73。基于性别的SMI分类对生存期的影响最大（p < 0.0001）；其预后价值独立于治疗方案或原发部位，并且在包含其他头颈部鳞状细胞癌特异性预后因素的总生存期多变量Cox回归分析中得以保留（p = 0.0004）。(4) 结论：个体化的SMI评估将改善接受放化疗、生物化疗或化学免疫治疗的头颈部鳞状细胞癌患者肌肉减少症的临床管理。基于性别的SMI可用于头颈部鳞状细胞癌患者的预后评估。
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