A Multicenter Prospective Observational Study of Nutritional Status in Locally Advanced Nasopharynx Cancer Treated by Induction Chemotherapy and Chemoradiotherapy

Abstract

We conducted a multicenter prospective study (NCT02575547) to investigate the effects of induction chemotherapy and concurrent chemoradiotherapy (IC-CCRT) on longitudinal nutritional status in locally advanced nasopharynx cancer (LA-NPC) patients. We further examined the association between nutritional status and survival. All patients with biopsy-proven LA-NPC and planned for IC-CCRT were recruited from ten institutions. IC entailed 2 cycles of docetaxel 75mg/m2/3w and cisplatin 75mg/m2/3w; CCRT entailed 2-3 cycles cisplatin 100mg/m2/3w and IMRT (70-72Gy/30-32fr). Study parameters included weight loss (WL), % of ideal body weight (%IBW), body mass index (BMI), nutrition risk screening 2002 (NRS2002), patient-generated subjective global assessment (PG-SGA), and EORTC QLQ-C30 that were collected at the following time-points: baseline (T1), 1 w pre-2nd IC (T2), 1 w pre-CCRT (T3), 4 w mid-CCRT (T4), end-CCRT (T5), 3 mo post-CCRT (T6), 1 y post-CCRT (T7), 2 y post-CCRT (T8). Primary endpoint was WL ≥5%; power calculations were based on a 10% estimated increase (from 59% to 69%) in proportion of patients with WL ≥5% following IC-CCRT compared to CCRT alone (historical). Secondary survival endpoints were OS, DFS, DMFS and LRRFS. Between June 2015 and November 2016, 186 patients were recruited; 171 were eligible for analysis. Median follow-up was 35.8 mo (range 12.3-46.1 mo). Compliance rates were 97.7% (167/171) and 87.7% (150/171) for IC and CCRT, respectively; all except one completed RT. The study met its primary endpoint with 70.2% of the study cohort experiencing WL ≥5%. Longitudinal evaluation of nutritional status for the cohort indicated the worst nutritional status at T5, with subsequent recovery by T8: 27.1% with %IBW <90%; 69.2% with WL ≥5%, which was also associated with a worsened QOL (OR = 6.23 for QOL change ≥25.0, P = 0.012) at T5. Baseline nutritional status was not associated with prognosis (P >0.05 for all). However, nutritional parameters at T5 were significantly associated with survival; %IBW <90% was the strongest predictor for inferior DMFS (HR = 2.669, 95%CI = 1.133-6.287) and OS (HR = 4.661, 95% CI = 1.113-19.508) among all parameters (multivariable-adjusted P <0.05). Subgroup analyses revealed that patients with %IBW <90% and WL ≥10% at T5 represented the most adverse subset of patients (see Table 1). Here, we comprehensively characterized the longitudinal nutritional status, including QoL in response to IC-CCRT for LA-NPC patients. We showed an interaction between systemic intensification and nutritional status that impacts on disease control, in particular distant metastasis. This is counter-intuitive and highlights the crucial importance of paracrine factors in optimizing treatment efficacy.Abstract 1208; Table 13-y LRRFS3-y DMFS3-y DFS3-y OS%IBW≥90% and WL<10%95.1%88.3%87.1%96.4%%IBW≥90% and WL≥10%91.6%97.4%88.9%100.0%%IBW<90% and WL<10%92.9%89.3%85.7%92.9%%IBW<90% and WL≥10%100.0%58.8%58.8%81.9% Open table in a new tab