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Background <p>Sarcopenia, characterized by loss of skeletal muscle mass, predicts adverse outcomes in head and neck cancer but is underrecognized due to reliance on third&#xa0;lumbar-level (L3) CT, which is not routinely performed. The third cervical vertebra (C3) is consistently imaged in head and neck cancer, offering a potential replacement for L3 sarcopenia assessment.</p> Methods <p>We conducted a systematic review and meta-analysis of studies reporting concurrent CT-derived skeletal muscle index at C3 and L3 in adult head and neck cancer patients. PubMed, Embase, Web of Science, and Cochrane Library were searched through August 30, 2025, without language restrictions. Pooled Pearson correlation coefficients between C3 and L3 measurements were calculated using a random-effects model. Subgroup analyses stratified by sex and BMI, as well as meta-regression, assessed potential modifiers.</p> Results <p>Fourteen studies encompassing 2017 head and neck cancer patients met the inclusion criteria. The overall pooled correlation between C3 and L3 muscle indices was 0.79 (95% CI: 0.73 to 0.84; I<sup>2</sup> = 90.3%). Sex-specific correlations were stronger (men: 0.92; women: 0.94), and BMI positively modified agreement (correlation increased from 0.70 at BMI 23 to 0.90 at BMI 27).</p> Conclusion <p>C3-derived muscle quantification demonstrates a strong correlation with L3 assessment, particularly when applying sex- and BMI-informed thresholds. Routine cervical imaging may enable accessible, radiation-sparing sarcopenia evaluation in head and neck cancer. Prospective multicenter studies are needed to standardize protocols and validate clinical utility.</p>

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From neck to abdomen: cervical (C3) muscle quantification as a surrogate to lumbar (L3) sarcopenia assessment in head and neck cancer: systematic review and meta‐analysis

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Mehrad Zare,
  • Alisa Mohebbi,
  • Mohammad Hossein Eslami,
  • Ali Abdi,
  • Afshin Mohammadi

摘要

Background

Sarcopenia, characterized by loss of skeletal muscle mass, predicts adverse outcomes in head and neck cancer but is underrecognized due to reliance on third lumbar-level (L3) CT, which is not routinely performed. The third cervical vertebra (C3) is consistently imaged in head and neck cancer, offering a potential replacement for L3 sarcopenia assessment.

Methods

We conducted a systematic review and meta-analysis of studies reporting concurrent CT-derived skeletal muscle index at C3 and L3 in adult head and neck cancer patients. PubMed, Embase, Web of Science, and Cochrane Library were searched through August 30, 2025, without language restrictions. Pooled Pearson correlation coefficients between C3 and L3 measurements were calculated using a random-effects model. Subgroup analyses stratified by sex and BMI, as well as meta-regression, assessed potential modifiers.

Results

Fourteen studies encompassing 2017 head and neck cancer patients met the inclusion criteria. The overall pooled correlation between C3 and L3 muscle indices was 0.79 (95% CI: 0.73 to 0.84; I2 = 90.3%). Sex-specific correlations were stronger (men: 0.92; women: 0.94), and BMI positively modified agreement (correlation increased from 0.70 at BMI 23 to 0.90 at BMI 27).

Conclusion

C3-derived muscle quantification demonstrates a strong correlation with L3 assessment, particularly when applying sex- and BMI-informed thresholds. Routine cervical imaging may enable accessible, radiation-sparing sarcopenia evaluation in head and neck cancer. Prospective multicenter studies are needed to standardize protocols and validate clinical utility.