Association of Body Mass Index With Outcomes Among Patients With Head and Neck Cancer Treated With Chemoradiotherapy

Abstract

ImportanceCombined modality therapy, such as chemoradiotherapy, often results in significant morbidity among patients with head and neck cancer. Although the role of body mass index (BMI) varies based on cancer subtypes, its association with treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer remains unclear.ObjectiveTo evaluate the role of BMI in treatment response, tumor recurrence, and survival outcomes among patients with head and neck cancer undergoing chemoradiotherapy.Design, Setting, and ParticipantsThis retrospective, observational, single-institution cohort study conducted at a comprehensive cancer center included 445 patients with nonmetastatic head and neck cancer who underwent chemoradiotherapy from January 1, 2005, to January 31, 2021.ExposureNormal vs overweight or obese BMI.Main Outcomes and MeasuresMetabolic response after chemoradiotherapy, locoregional failure (LRF), distant failure (DF), overall survival (OS), and progression-free survival (PFS), with Bonferroni correction used to adjust for multiple comparisons and P < .025 being considered statistically significant.ResultsA total of 445 patients (373 men [83.8%]; median age, 61 years [IQR, 55-66 years]; 107 [24.0%] with normal BMI, 179 [40.2%] with overweight BMI, and 159 [35.7%] with obese BMI) were included for analysis. Median follow-up was 48.1 months (IQR, 24.7-74.9 months). On Cox proportional hazards regression multivariable analysis, only overweight BMI was associated with improved OS (5-year OS, 71.5% vs 58.4%; adjusted hazard ratio [AHR], 0.59 [95% CI, 0.39-0.91]; P = .02) and PFS (5-year PFS, 68.3% vs 50.8%; AHR, 0.51 [95% CI, 0.34-0.75]; P < .001). On logistic multivariable analysis, overweight BMI (91.6% vs 73.8%; adjusted odds ratio [AOR], 0.86 [95% CI, 0.80-0.93]; P < .001) and obese BMI (90.6% vs 73.8%; AOR, 0.89 [95% CI, 0.81-0.96]; P = .005) were associated with complete metabolic response on follow-up positron emission tomography–computed tomography after treatments. On Fine-Gray multivariable analysis, overweight BMI was associated with reduction in LRF (5-year LRF, 7.0% vs 25.9%; AHR, 0.30 [95% CI, 0.12-0.71]; P = .01), but not DF (5-year DF, 17.4% vs 21.5%; AHR, 0.92 [95% CI, 0.47-1.77]; P = .79). Obese BMI was not associated with LRF (5-year LRF, 10.4% vs 25.9%; AHR, 0.63 [95% CI, 0.29-1.37]; P = .24) or DF (5-year DF, 15.0% vs 21.5%; AHR, 0.70 [95% CI, 0.35-1.38]; P = .30).ConclusionIn this cohort study of patients with head and neck cancer, when compared with normal BMI, overweight BMI was an independent factor favorably associated with complete response after treatments, OS, PFS, and LRF. Further investigations are warranted to improve understanding on the role of BMI among patients with head and neck cancer.

Predictive Factors for Critical Weight Loss in Saudi Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy

“…Similar to what was reported by several studies [12,[15][16][17][18], our study found that critical weight loss was more pronounced and independently associated with our study population who had a high pretreatment BMI. The majority of our study population had a higher pretreatment BMI: overweight (28%) and obese (26%).…”

“…This finding contrasts with those of two studies that found no significant relationship between pretreatment BMI and critical weight loss among cancer patients with several types including HNC undergoing radiotherapy [6,19]. Furthermore, in recent research conducted by Ma et al [15], they observed that HNC patients with a high BMI (overweight or obese) experienced significant weight loss. However, these patients were found to have more positive outcomes, such as improved treatment response, greater overall survival, and increased progression-free survival.…”

Prognostic importance of modified geriatric nutritional risk index in oral cavity squamous cell carcinoma

“…Patients with OCSCC may exhibit lower BMI values than do individuals in the general population owing to the effects of the cancer and cancer-associated dysphagia; therefore, the mGNRI provides additional insight into patients’ condition by accounting for the patients’ ideal weight, thereby offering a more objective evaluation of the patients’ weight. A previous study observed that being underweight at head and neck cancer (HNC) diagnosis was an independent risk factor for unfavorable prognosis 35 ; conversely, overweight was associated with the likelihood of complete response after CRT 36 . These observations could be linked to cancer-related chronic wasting, oxidative stress, and the high protein metabolism induced by cancer cachexia 37 .…”

Obesity and Survival After Immune Checkpoint Inhibition for Head and Neck Squamous Cell Carcinoma

“…Numerous studies of regions outside the head and neck (renal cell carcinoma, metastatic melanoma, and several others) have demonstrated that obesity is associated with improved oncologic survival in patients with ICI treatment. A retrospective, single-institution cohort study of 445 patients with head and neck cancer of various types and treated with chemoradiotherapy found that pretreatment overweight BMI, but not obesity BMI, was an independent factor associated with improved OS and progression-free survival (PFS) . Zhang et al conducted a retrospective review of 49 patients at a single institution in China who received anti–PD-1 therapy (pembrolizumab) for recurrent or metastatic HNSCC.…”