151751-Najiba-Chargi

374 CHAPTER 18 Table 6. Subgroup analyses according to TNM-stage and sarcopenia showed sarcopenia as a statistically significant prognostic factor for overall survival in all patients with curative treatment intention (HR 2.80; 95% CI 1.14-6.88; p=0.03) and in all patients with TNM-stage I-III (HR 9.19; 95% CI 1.07-78.74; p=0.04) Subgroup Overall survival Sarcopenia Frequency HR 95% CI P-value TNM-stage I-III 32 9.19 1.07-78.74 0.04* TNM-stage IV 39 0.90 0.32-2.55 0.85 Curative treatment intention 71 2.80 1.14-6.88 0.03* *. Correlation is significant at the 0.05 level (2-tailed) DISCUSSION Sarcopenia is a common and highly prevalent clinical problem in the elderly patient. Literature showed that sarcopenia is associated with several negative outcomes, however literature mainly focuses on radiologically assessed low SMM rather than the combination of SMM and MF. 6,7,16,8–15 In addition, no studies report on the impact of sarcopenia on survival in the elderly head and neck cancer patient. Identification of the impact of lowSMM and lowMF on prognosis in the elderly head and neck cancer patient will stimulate the development of novel interven- tions to gain SMM and MF which may improve the prognosis of these patients. Regardless of the success of an intervention, information on prognosis can be used for patient counseling and treatment decision making. In this study, we included 85 patients of whom 41 patients (48.2%) were classified as sar - copenic. This number is in accordance with recent medical literature which estimated the prevalence of sarcopenia in elderly patients diagnosed with different types of cancer between 14%-78.7%. 21 The prevalence estimates of sarcopenia in the elderly non-cancer patients are lower, ranging between 5-50%. Sarcopenia is prevailing in elderly cancer patients because of the frequent weight loss caused by low food intake, increased catabolic pathways, increased inflammation, increased lipolysis and increased proteolysis associated with both old age and malignancy. 21 This study shows that SMM, muscle strength and physical functioning separately had no signif- icant prognostic value for overall survival. A combination of muscle mass andmuscle strength or muscle performance did show a significant prognostic value for overall survival in elderly patients with head and neck cancer. This is in accordance with previous studies in other tumor types, which have demonstrated that not only SMM but also MF is related with several health outcomes 21–23 . Previous studies in patients with esophageal cancer did not show a significant prognostic value of sarcopenia on overall survival, however sarcopenia was defined as low