SARCOPENIA was linked to significantly poorer survival in patients with head and neck squamous cell carcinoma (HNSCC), according to a meta-analysis of 22,408 patients, with inflammation further strengthening its prognostic value.
HNSCC is the most common type of head and neck cancer, arising from the lining of the mouth, throat and related structures. The findings also suggested that combining sarcopenia with markers of inflammation identified patients at even greater risk of adverse outcomes. The analysis indicated that while sarcopenia alone was associated with reduced overall and disease-free survival, adding inflammation substantially strengthened its prognostic value.
Researchers conducted a systematic review of PubMed, Web of Science and Embase to identify studies comparing survival outcomes in patients with HNSCC according to the presence or absence of sarcopenia and concurrent inflammation.
The meta-analysis included 26 studies involving 22,408 patients, with mean ages ranging from 51 to 73 years. Men accounted for 85.5% of the study population.
Patients with sarcopenia experienced poorer overall survival, with a pooled hazard ratio (pHR) of 1.89 (p<0.001), and poorer disease-free survival, with a pHR of 2.01 (p<0.001). When sarcopenia and inflammation were assessed together, the reduction in survival was substantially greater, with a pHR of 14.56 for overall survival and 5.92 for disease-free survival (both p<0.001).
The analysis found similar prognostic performance regardless of whether sarcopenia was measured at the third cervical vertebra (C3) or the third lumbar vertebra (L3). There was no significant difference between the two approaches for overall survival or disease-free survival, suggesting both radiological assessment methods performed comparably.
The findings suggested that sarcopenia independently identified patients with HNSCC who were more likely to experience poorer survival, while inflammatory status further strengthened prognostic stratification. The comparable performance of C3- and L3-based imaging criteria may provide flexibility when incorporating sarcopenia into radiological evaluation.
As the study pooled previously published evidence, the findings supported the prognostic value of sarcopenia and inflammation but did not establish a causal relationship with clinical outcomes. The evidence base was also heavily weighted towards men, who accounted for 85.5% of the 22,408 participants, which may limit the generalisability of the findings to the broader HNSCC population.
Reference
Zhang H et al. Sarcopenia as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Eur Radiol. 2026;DOI:10.1007/s00330-026-12754-7.
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