Skeletal muscle mass and surgical outcome in neuro-oncology

Objective Glioblastoma is the most common and aggressive primary brain tumor in adults, with limited therapeutic options and a poor prognosis. Sarcopenia, a key characteristic of frailty, is a predictor of postoperative complications and survival in oncologic patients. However, the role of skeletal muscle mass (SMM) as marker of sarcopenia to predict outcomes in neuro-oncology remains unclear. Therefore, we have evaluated the association of SMM with outcomes in patients undergoing glioblastoma surgery. Methods In this retrospective cohort study, 159 adult patients who underwent glioblastoma surgery were analyzed. Preoperative MRI was used to quantify temporal, masseter, and pterygoid muscle thickness. Clinical endpoints included surgical complications (Clavien-Dindo), length of hospital stay (LoS) and postoperative Karnofsky Performance Score (KPS). Multivariable regression analyses were performed, adjusting for known confounders including age, sex, body size, and ASA classification. Results Patients (66% male) were 58 ± 13 years and 8% developed minor complications. Mean temporal, masseter and pterygoid muscle thickness were 8.4 ± 1.7, 17.2 ± 2.9 and 15.5 ± 1.9 mm, respectively, but were not associated with surgical complications, LoS, postoperative KPS. Sensitivity analyses using two previously published sarcopenia cut-off values showed that 6.3 and 20.8% of our patients were sarcopenic, but did not demonstrate prognostic significance. Conclusion In a carefully selected cohort of glioblastoma patients fit for surgery, SMM does not seems to predict clinical outcomes. Future studies including broader patient populations are warranted to fully determine the prognostic value of SMM in glioblastoma management.