Predicting treatment intolerance in operable head and neck cancer using the modified head and neck surgery risk index

In 568 patients, including 343 in the derivation and 225 in the validation cohort, the mean age was 65 with 228 (40%) patients being frail and 259 (46%) sarcopenic. Treatment intolerance occurred in 270 (48%) patients. Independent predictors of treatment intolerance included low cervical paraspinal SMI, elevated Risk Analysis Index (RAI), reduced high-to-low attenuation SMI ratio and obesity. Sarcopenia and frailty had a synergistic effect on treatment intolerance. Adding cervical paraspinal SMI and high-to-low attenuation SMI ratio improved model performance (Δc-statistic 0.069, P = 0.05). The mHNSRI had an AUC of 0.71 (95% CI:0.61-0.80) in external validation cohort and demonstrated superior predictive ability compared to the RAI (Δc 0.14, modified Frailty Index-5 (Δc 0.13), ASA (Δc 0.2) and Charlson Comorbidity Index (Δc 0.14, all P < 0.05) CONCLUSION: The mHNSRI offers a personalized approach to preoperative risk stratification in HNC surgery, integrating sarcopenia and frailty metrics to better predict treatment intolerance.