The Influence of Nutritional and Immunological Status on the Prognosis of Head and Neck Cancer

Abstract

Head and neck cancer (HNC) is a big global health problem representing 4% of all malignancies. It is the fifth cause of cancer-related deaths worldwide with estimation of more than half of a million newly diagnosed patients. Despite the development of diagnosis and treatment, the overall survival of HNC is still low. Recently, the well recognition of interaction of host immune system and cancer cell has led to realize the processes of tumor initiation, progression and metastasis. Many systemic inflammatory response has been shown to play a crucial role in cancer progression. The pretreatment nutritional and immunological status of HNC patients are reliable prognostic indicators on the tumor outcomes and survivor. The nutritional status was assessed by body weight loss, body mass index (BMI), albumin, hemoglobin (Hb), quality of life (QoL), protein and caloric intake, resting energy expenditure (REE) and cachexia. The immunological status was evaluated by pretreatment C-reactive protein (CRP), platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), modified Glasgow prognostic score (mGPS), and inflammatory cytokines. These patient-related prognostic factors are the crucial determinants independent of the TNM Classification (TNM) system in HNC patients. This article reviews how these factors influence the treatment outcomes and survival on the HNC patients and set up as a stratification model to predict prognosis. The impact on nutritional status is not only before the cancer treatment, it can influence during and after any kinds of management. Dietary counseling and nutritional support is important on the whole course of HNC treatment.