Abstract
OBJECTIVE: To investigate the impact of sarcopenia assessed by pretherapy magnetic resonance imaging (MRI) of the third cervical vertebra (C3) on the survival of patients with locally advanced nasopharyngeal carcinoma (LANPC). METHODS: We analyzed the clinical information of 478 patients with LANPC who underwent radiotherapy between July 2016 and June 2019. Sarcopenia was evaluated using the skeletal muscle mass index, which was determined based on an MRI of the C3. The cutoff values for sarcopenia were determined using receiver operating characteristic curves. The thresholds were < 12.83 cm(2)/m(2) for male and < 11.15 cm(2)/m(2) for female. Comparisons between patients with and without sarcopenia were conducted using the chi-squared test. The Kaplan-Meier method was applied to plot survival curves, which were then assessed using the log-rank test. Survival factors were identified using univariate and multivariate analyses. RESULTS: The 5-year overall survival (OS) rate was 75.3%, with a median follow-up period of 59 months. Patients with sarcopenia (181/478) had a lower OS than those without sarcopenia (70.7% vs 78.1%, hazard ratio = 1.87, 95% confidence interval: 1.26-2.77, P < 0.01). Sarcopenia was elevated in patients with advanced T-stage tumors and a low body mass index. Univariate and multivariate analyses showed that sarcopenia, age, sex, T stage, and N stage were significant variables that affected the OS of patients with LANPC (P < 0.05). CONCLUSIONS: MRI-based sarcopenia is significantly correlated with the OS of patients with LANPC. This finding highlights the importance of evaluating sarcopenia before treatment, as it can guide personalized treatment programs, thereby enhancing patient prognosis.