Nutrients (Jan 2024)

Ultrasound Muscle Evaluation for Predicting the Prognosis of Patients with Head and Neck Cancer: A Large-Scale and Multicenter Prospective Study

  • Rocío Fernández-Jiménez,
  • Silvia García-Rey,
  • María Carmen Roque-Cuéllar,
  • María Luisa Fernández-Soto,
  • María García-Olivares,
  • María Novo-Rodríguez,
  • María González-Pacheco,
  • Inmaculada Prior-Sánchez,
  • Alba Carmona-Llanos,
  • Concepción Muñoz-Jiménez,
  • Felisa Pilar Zarco-Rodríguez,
  • Luis Miguel-Luengo,
  • Hatim Boughanem,
  • Pedro Pablo García-Luna,
  • José Manuel García-Almeida

DOI
https://doi.org/10.3390/nu16030387
Journal volume & issue
Vol. 16, no. 3
p. 387

Abstract

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Head and neck cancer (HNC) is a prevalent and aggressive form of cancer with high mortality rates and significant implications for nutritional status. Accurate assessment of malnutrition in patients with HNC is crucial for optimizing treatment outcomes and improving survival rates. This study aimed to evaluate the use of ultrasound techniques for predicting nutritional status, malnutrition, and cancer outcomes in patients with HNC. A total of 494 patients with HNC were included in this cross-sectional observational study. Various tools and body composition measurements, including muscle mass and adipose tissue ultrasound evaluations, were implemented. Using regression models, we mainly found that high levels of RF-CSA (rectus femoris cross-sectional area) were associated with a decreased risk of malnutrition (as defined with GLIM criteria (OR = 0.81, 95% CI: 0.68–0.98); as defined with PG-SGA (OR = 0.78, 95% CI: 0.62–0.98)) and sarcopenia (OR = 0.64, 95% CI: 0.49–0.82) after being adjusted for age, sex, and BMI. To predict the importance of muscle mass ultrasound variables on the risk of mortality, a nomogram, a random forest, and decision tree models were conducted. RF-CSA was the most important variable under the random forest model. The obtained C-index for the nomogram was 0.704, and the Brier score was 16.8. With an RF-CSA 2, patients with a low RF-CSA value lower than 2.7 cm2 had worse survival rates (p < 0.001). The findings of this study highlight the importance of implementing ultrasound tools, for accurate diagnoses and monitoring of malnutrition in patients with HNC. Adipose tissue ultrasound measurements were only weakly associated with malnutrition and not with sarcopenia, indicating that muscle mass is a more important indicator of overall health and nutritional status. These results have the potential to improve survival rates and quality of life by enabling early intervention and personalized nutritional management.

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