The effect of myopenia, myosteatosis, and inflammatory markers on prognosis in laryngeal cancer patients treated with definitive radiotherapy

In this study, we aimed to investigate the prognostic significance of myopenia, myosteatosis, and inflammatory markers in patients with laryngeal cancer treated with definitive radiotherapy. A total of 146 patients who underwent definitive radiotherapy for laryngeal cancer between 2015 and 2024 were included. Myopenia and myosteatosis were evaluated using the masseter muscle index (MMI) and the Hounsfield Unit Average Calculation (HUAC), respectively. All measurements were obtained from a single axial CT slice acquired 2 cm below the zygomatic arch. The Global Immune–Nutrition–Inflammation Index (GINI) was used as the inflammatory biomarker and was calculated using its original formula: GINI = [(C-reactive protein × Monocytes × Platelets × Neutrophils) ÷ (Albumin × Lymphocytes)]. Receiver operating characteristic (ROC) curve analysis was performed to establish the optimal cutoff values for MMI, HUAC, and GINI. Survival outcomes in relation to myopenia, myosteatosis, and GINI were assessed using the Kaplan–Meier method and compared using the log-rank test. Additionally, univariate and multivariate Cox proportional hazards regression analyses were conducted to determine the independent prognostic effects of these parameters on OS and PFS. The median follow-up duration was 50 months, and the mean overall survival was 89.6 months. ROC analysis identified optimal cutoff values of 139,67 for GINI and 2.83 cm²/m² for MMI. Patients with high GINI values had significantly shorter OS (p < 0.001), PFS (p < 0.001), and LRFS (p = 0.008) than those with low GINI values. Similarly, low MMI was associated with significantly shorter OS (p < 0.001), PFS (p < 0.001), and LRFS (p = 0.004) compared with high MMI. In multivariate analysis, both GINI and MMI emerged as independent prognostic factors for OS (p = 0.004 for GINI; p = 0.016 for MMI) and PFS (p = 0.003 for GINI; p = 0.019 for MMI). These findings suggest that pretreatment MMI and GINI may serve as promising biomarkers for predicting survival outcomes in patients with laryngeal cancer undergoing definitive radiotherapy.