The predictive and prognostic role of radiologically defined sarcopenia in head and neck cancer: a systematic review and multi-level meta-analysis

Hugo C van Heusden; Maartje A van Beers; Anouk W M A Schaeffers; Emma Swartz; Justin E Swartz; Remco de Bree

doi:10.1038/s41416-025-03049-7

The predictive and prognostic role of radiologically defined sarcopenia in head and neck cancer: a systematic review and multi-level meta-analysis

Br J Cancer. 2025 Jun 2. doi: 10.1038/s41416-025-03049-7. Online ahead of print.

Authors

Hugo C van Heusden¹, Maartje A van Beers¹, Anouk W M A Schaeffers¹, Emma Swartz², Justin E Swartz^{1

3}, Remco de Bree⁴

Affiliations

¹ Department of Head and Neck Surgical Oncology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
² Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands.
³ Department of Otorhinolaryngology - Head and Neck Surgery, Diakonessenhuis, Utrecht, Utrecht, The Netherlands.
⁴ Department of Head and Neck Surgical Oncology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. r.debree@umcutrecht.nl.

PMID: 40456925
DOI: 10.1038/s41416-025-03049-7

Abstract

Radiologically defined sarcopenia (RS), defined as a lack of skeletal muscle mass (SMM) measured on cross-sectional CT or MR imaging, is increasingly recognized as a significant prognostic determinant in head and neck cancer (HNC). A systematic literature search of Embase and Medline was performed to identify studies investigating the impact of pre-treatment sarcopenia on the prognosis of HNC patients. All available survival and other treatment-related outcomes were extracted and analyzed in a multi-level meta-analysis. Sixty-three studies comprising data from 14,804 patients were analyzed. The overall estimated log OR was 0.644 (95% CI = 0.505-0.783, p < 0.001), suggesting that patients with RS have a higher risk of worse outcomes. In 43 studies there was a significant effect of sarcopenia on survival, with a log OR of 0.808 (95% CI = 0.509-1.107, p < 0.001). In 15 studies RS was shown to be a risk factor for treatment-related complications (log OR = 0.669, 95% CI = 0.441-0.897, p < 0.001). We conclude that pre-treatment radiologically defined sarcopenia is a robust prognostic and predictive factor in HNC patients and is associated with worse survival and increased risk of treatment-related complications.

Publication types

Review