Abstract
Only few prospective cohort trials have evaluated the risk factors for the 2-year mortality rate between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC): oral cavity cancer with adjuvant concurrent chemoradiotherapy (CCRT) (OCC) and non-oral cavity cancer with primary CCRT (NOCC), under the recommended calorie intake and investigated the interplay among calorie supply, nutrition–inflammation biomarkers (NIBs), and total body composition change (TBC), as assessed using dual-energy X-ray absorptiometry (DXA). Patients with LAHNSCC who consumed at least 25 kcal/kg/day during CCRT were prospectively recruited. Clinicopathological variables, blood NIBs, CCRT-related factors, and TBC data before and after treatment were collected. Factor analysis was performed to reduce the number of anthropometric and DXA-derived measurements. Cox proportional hazards models were used for analysis. We enrolled 123 patients with LAHNSCC (69 with OCC and 54 with NOCC). The mean daily calorie intake correlated with the treatment interval changes in total body muscle and fat. Patients consuming ≥30 kcal/kg/day had lower pretreatment levels but exhibited fewer treatment interval changes in anthropometric and DXA measurements than patients consuming <30 kcal/kg/day. In the multivariate analysis of the 2-year mortality rate, the prognostic influence of the recommended calorie intake could not be confirmed, but different risk factors (performance status, pretreatment platelet-to-lymphocyte ratio, and treatment interval body muscle changes in patients with OCC; age, pretreatment neutrophil-to-lymphocyte ratio, and body fat storage in patients with NOCC) showed independent effects. Therefore, the inflammation status and body composition, but not the recommended calorie supply, contribute to the 2-year mortality rate for patients with LAHNSCC receiving CCRT.
Highlights
Most patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC)require concurrent chemoradiotherapy (CCRT) as either adjuvant therapy following surgery for patients with oral cavity cancer (OCC), or curative-intent primary CCRT therapy for patients with non-oral cavity cancer (NOCC, pharynx, larynx, and paranasal sinus), to improve disease control [1,2]
The mechanisms underlying the progression of malnutrition in patients with LAHNSCC can be attributed to inadequate energy intake and aberrant metabolism caused by varied degrees of systemic inflammation induced by cancer, treatment, or both [6,13,14]
Under the provision of the recommended daily calorie intake during the treatment, this study aimed to identify potential factors contributing to the 2-year mortality rate of patients with LAHNSCC receiving CCRT by simultaneously analyzing all covariates, including clinicopathological variables, blood nutrition–inflammation biomarkers (NIBs), treatment-related profiles, and dual-energy X-ray absorptiometry (DXA)-associated measurements
Summary
Most patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC)require concurrent chemoradiotherapy (CCRT) as either adjuvant therapy following surgery for patients with oral cavity cancer (OCC), or curative-intent primary CCRT therapy for patients with non-oral cavity cancer (NOCC, pharynx, larynx, and paranasal sinus), to improve disease control [1,2]. The mechanisms underlying the progression of malnutrition in patients with LAHNSCC can be attributed to inadequate energy intake and aberrant metabolism caused by varied degrees of systemic inflammation induced by cancer, treatment, or both [6,13,14]. According to the European Society for Clinical Nutrition and Metabolism (ESPEN), the energy requirement for each patient with cancer is a total intake of at least 25–30 kcal/kg/day over the treatment course [15]. This recommendation is not supported by sufficient evidence [15], and the effect of the recommended calorie intake during CCRT on the prognostic outcomes is seldom addressed.
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