title: Cachexia at diagnosis is associated with poor survival in head and neck cancer patients.
abstract: CONCLUSIONS
  One third of the patients had cachexia with an association of significantly shorter survival. These results suggest that combining HGS and MAMA seems to be a practical method to screen cachexia in patients with head and neck cancer and may also be used when assessing their prognosis.
  
  
  OBJECTIVE
  The aim of this study was to analyze the hypothesis that cachexia defined as both low mid-arm muscle area (MAMA) and handgrip strength (HGS) is associated with decreased survival in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Sixty-five consecutive patients with primary HNSCC were enrolled prior to cancer therapy. Cachexia was defined as low handgrip strength (HGS) and low mid-arm muscle area (MAMA). Nutritional status was assessed by patient-generated subjective global assessment (PG-SGA) and sarcopenia by low MAMA. Biochemical parameters reflecting nutritional status and S-25-OHD were measured.
  
  
  RESULTS
  Cachexia was seen in 31% and sarcopenia in 46% of patients. Altogether, 34% of patients were malnourished. Disease-free survival was 13 months (3-62) in cachectic patients, compared with 66 months (31-78) in non-cachectic patients (p = 0.009). S-25-OHD was 28 nmol/l in cachectic patients, compared with 46 nmol/l in non-cachectic patients (p = 0.009) and prealbumin 187 mg/l and 269 mg/l, respectively (p < 0.001).
authors.affiliation: a Department of Clinical Nutrition Therapy , Helsinki University Hospital , Helsinki , Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Orell-Kotikangas
authors.affiliation: b Department of Oncology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Österlund
authors.affiliation: c Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Mäkitie
authors.affiliation: b Department of Oncology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
authors.forename: Kauko
authors.initials: K
authors.lastname: Saarilahti
authors.affiliation: d Laboratório de Nutrição e Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Hospital Universitário de Santa Maria , Lisbon , Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Ravasco
authors.affiliation: e Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland , Kuopio , Finland.|f Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital , Kuopio , Finland.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schwab
authors.affiliation: g Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.|h Department of Otorhinolaryngology - Head & Neck Surgery , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
authors.forename: Antti A
authors.identifier: http://orcid.org/0000-0002-0451-2404
authors.initials: AA
authors.lastname: Mäkitie
mesh_terms: D000328:Adult; D000368:Aged; D002100:Cachexia / Q000209:etiology* / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Nutritional status; anthropometry; handgrip strength; oncology