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@ARTICLE{Haehl:182795,
      author       = {E. Haehl$^*$ and L. Alvino and A. Rühle$^*$ and J. Zou$^*$
                      and A. Fabian$^*$ and A.-L. Grosu$^*$ and N. H. Nicolay$^*$},
      title        = {{S}arcopenia as a {P}rognostic {M}arker in {E}lderly {H}ead
                      and {N}eck {S}quamous {C}ell {C}arcinoma {P}atients
                      {U}ndergoing ({C}hemo-){R}adiation.},
      journal      = {Cancers},
      volume       = {14},
      number       = {22},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2022-02927},
      pages        = {5536},
      year         = {2022},
      note         = {#LA:E055#},
      abstract     = {Sarcopenia is associated with reduced survival and
                      increased toxicity in malignant diseases. The prevalence of
                      sarcopenia increases with age and is an important cause of
                      functional decline. We analyzed sarcopenia and sarcopenia
                      dynamics in elderly head-and-neck squamous cell carcinoma
                      (HNSCC) patients undergoing (chemo)radiation. Skeletal
                      muscle mass of 280 elderly HNSCC-patients (>65 yrs)
                      receiving curative (chemo)radiation was manually outlined
                      and quantified on CT scans at the level of the C3 (C3MA).
                      Cross-sectional muscle area at L3 (L3MA) was calculated and
                      normalized to height (L3MI). Frequency distributions of
                      clinical parameters as well as overall survival (OS),
                      progression-free survival (PFS) and locoregional control
                      (LRC) were calculated regarding sarcopenia. Calculated L3MA
                      correlated with pretherapeutic hemoglobin-levels (ρ =
                      0.280) bodyweight (ρ = 0.702) and inversely with
                      patient-age (ρ = -0.290). Sarcopenic patients featured
                      larger tumors (T3/4 $69.0\%$ vs. $52.8\%,$ p < 0.001), a
                      higher burden of comorbidity (age-adjusted Charlson
                      Comorbidity Index 4.8 vs. 4.2, p = 0.015) and more severe
                      chronic toxicities (CTCAE grade 3/4 $24.0\%$ vs. $11.8\%,$ p
                      = 0.022). OS was significantly deteriorated in sarcopenic
                      patients with a median of 23 vs. 91 months (logrank p =
                      0.002) (HR 1.79, CI 1.22-2.60, p = 0.003) and sarcopenia
                      remained an independent prognostic factor for reduced OS in
                      the multivariate analysis (HR 1.64, CI 1.07-2.52, p =
                      0.023). After therapy, $33\%$ of previously non-sarcopenic
                      patients developed sarcopenia, while $97\%$ of pre-treatment
                      sarcopenic remained sarcopenic. Median bodyweight decreased
                      by $6.8\%,$ whereas median calculated L3MA decreased by
                      $2.4\%.$ In contrast to pretherapeutic, post-therapeutic
                      sarcopenia is no prognosticator for reduced OS.
                      Pretherapeutic sarcopenia is a significant prognostic factor
                      in elderly HNSCC patients undergoing (chemo-)radiation and
                      should be considered in pretherapeutic decision-making. Its
                      role as a predictive marker for tailored supportive
                      interventions merits further prospective evaluation.},
      keywords     = {HNSCC (Other) / elderly (Other) / head-and-neck cancer
                      (Other) / head-and-neck squamous cell carcinoma (Other) /
                      radiotherapy (Other) / sarcopenia (Other)},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36428629},
      doi          = {10.3390/cancers14225536},
      url          = {https://inrepo02.dkfz.de/record/182795},
}