Prognostic impact of osteosarcopenia in patients with head and neck cancer undergoing radical resection and reconstructive surgery

PURPOSE: Osteosarcopenia, i.e., the coexistence of sarcopenia and osteopenia, has emerged as a marker of systemic frailty. The prognostic significance of osteosarcopenia in head and neck cancer (HNC) patients who undergo radical surgery with reconstruction is unclear. METHODS: We retrospectively analyzed the cases of 127 HNC patients who underwent radical resection and reconstructive surgery. We used preoperative computed tomography to measure the skeletal muscle index (SMI) at the L3 level and L1 vertebral Hounsfield units (HU) to assess bone mineral density. Osteopenia was defined using a receiver operating characteristic (ROC)-derived cutoff of 107 HU. Sarcopenia was defined according to established criteria. Osteosarcopenia was defined as the coexistence of both osteopenia and sarcopenia. Overall survival (OS) and disease-free survival (DFS) were evaluated by a Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: The SMI showed limited predictive ability for 2-year OS (AUC = 0.594); the L1 HU value demonstrated moderate performance (AUC = 0.667). Patients with osteosarcopenia had significantly worse OS (p < 0.001) and DFS (p = 0.0002) than those without. In a four-group analysis (normal, sarcopenia-alone, osteopenia-alone, and osteosarcopenia), the osteosarcopenia group showed the poorest survival. The multivariate analysis identified osteosarcopenia as an independent prognostic factor for OS (HR 3.91, 95%CI: 1.95-7.86, p = 0.0001) and DFS (HR 3.11, 95%CI: 1.75-5.53, p = 0.0001), along with the prognostic nutritional index. CONCLUSION: Preoperative osteosarcopenia is a strong independent prognostic factor in HNC patients undergoing reconstructive surgery. A combined assessment of muscle and bone status plus a nutritional evaluation may improve the risk stratification and perioperative management in this population.