Temporalis and Masseter Muscle Thickness as Proxy Measures of Sarcopenia and Frailty in Sinonasal Malignancy

Background: Squamous cell carcinoma of the sinonasal tract (SNSCC) and sinonasal adenocarcinoma (SNAC) are two common types of sinonasal cancer. In other malignancies, sarcopenia is associated with reduced overall survival (OS) and higher rates of postoperative complications. Traditionally, sarcopenia is assessed with whole body computed tomography with an advanced measurement algorithm. Recently, the temporalis muscle thickness (TMT) and masseter muscle thickness (MMT) have been used as proxies for sarcopenia and frailty in patients with neurological pathology as the measurements are readily available, facile to collect, and may correlate well with the classically-described methods.

Objectives: No study has assessed the use of TMT and MMT as measures of sarcopenia in SNSCC and SNAC. The objective of this study is to evaluate the use of TMT and MMT in patients with SNSCC and SNAC as measures of sarcopenia and proxies for frailty. We hypothesized that lower TMT and MMT would be associated with worsened OS, 30-day readmission, and progression free survival (PFS).

Methods: Patients were included if they had magnetic resonance (MR) imaging of the head/brain completed within 6 months of biopsy-confirming diagnosis. Bilateral TMT and MMT measurements were manually performed on pre-treatment MR images using Picture Archiving and Communication Systems (PACS) software. The primary outcome of interest was overall survival (OS), with secondary outcomes including 30-day readmission and progression-free survival. Data on postoperative complications and recurrence were also collected.

Results: 59 (22 F, 37 M) patients with SNSCC and 19 (10F, 9M) patients with SNAC were included in this study. The average age of patients was 60.3 ± 14.6 years and 61.2 ± 18.4 years for SNSCC and SNAC, respectively (p = 0.42). On multivariate analysis, TMT did not correlate with OS (HR 1.05 (0.77–1.40); p = 0.75), 30-day readmission (HR 0.92 (0.69–1.24); p = 0.59), or PFS (HR: 1.14 (0.92–1.41); p = 0.23). Additionally, MMT did not correlate with OS (HR 1.05 (0.86–1.26); p = 0.6), 30-day readmission (HR 0.95 (0.74–2.23); p = 0.7) or PFS (HR 0.94 (0.78–1.11); p = 0.52).

Conclusions: This is the first study to examine TMT and MMT measured on MR images as markers for sarcopenia and frailty in patients with SNSCC and SNAC. TMT and MMT measurements were not associated with OS, 30-day readmission, and PFS in our population. A multi-institutional study with larger patient numbers and additional pathology types is needed to further investigate TMT and MMT measurements as proxies for frailty in sinonasal cancer.

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Artikel online veröffentlicht:
05. Februar 2024