Determining Malnutrition Assessment Criteria to Predict One-Year Mortality for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

Abstract

Study on the impact of pretreatment malnutrition on treatment outcomes in locally advanced head and neck cancer (LAHNC) patients is still lacking. We prospectively collected various malnutrition assessment methods including nutrition indexes, inflammatory biomarkers, and lean body mass index (LBMI) data before treatments. The one year mortality rate was assessed, and the factors associated with this outcome were investigated. Furthermore, the association between malnutrition assessment methods was examined. A total of 113 patients were enrolled. By prognostic stratification based on the prognostic nutritional index (PNI) and platelet-to-lymphocyte ratio (PLR) combination, the low PNI/high PLR group had highest and the high PNI/low PLR group had the lowest mortality rate. Furthermore, the PNI was positively correlated with the LBMI, and the PLR was inversely correlated with the LBMI. PNI and PLR were found to be independent prognostic factors of one year mortality and also associated with the loss of muscle.

Prognostic Nutritional Index Predicts Toxicity in Head and Neck Cancer Patients Treated with Definitive Radiotherapy in Association with Chemotherapy

“…The results from this study may help to reach beyond the limits of PNI application in clinical practice. Firstly, a cut-off value to stratify patients is still lacking with investigations on the topic suggesting values ranging from 40 to 52 [ 31 , 32 , 33 , 34 , 39 ], and our cut-off was in line with current literature. Secondly, radiation technique for HNC is in continuous evolution towards advanced treatment modalities that are associated with low toxicity.…”

“…Nonetheless, few reports have investigated the role of PNI in HNC, so far. In most of the published studies, higher pre-treatment PNI was associated with a better outcome and OS in HNC patients who underwent surgery [ 31 , 32 , 53 , 54 ] as well as in those who were treated with definitive radiotherapy [ 33 , 34 ]. In our study, we included only HNC patients treated with definitive radiotherapy with sequential or concurrent chemotherapy and, our results showed a possible role on DFS and OS prediction, in line with previously published data.…”

“…Therefore, PNI has also been recognized as an accurate parameter reflecting nutritional and inflammation status [ 19 ]. In the last few years, PNI has been extensively investigated as predictor of poor outcome in several types of cancer [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], including HNC [ 31 , 32 , 33 , 34 ]. Although a number of studies have evaluated PNI in relation to treatment toxicity [ 35 , 36 , 37 , 38 ], only few ones focused on HNC [ 39 , 40 , 41 , 42 ].…”

Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment

“…For survival data, longer-term outcomes may be more relevant to look at in HNC cohorts given in 2012–2016 the five-year relative survival for HNC was 71% [ 1 ]. A low prognostic nutritional index has recently been found to be an independent prognostic factor for prediction of one-year mortality in a study of 113 patients with locally advanced HNC [ 40 ], suggesting that one year may be a more valid timeframe in HNC cohorts.…”

Nutritional Status as a Predictive Biomarker for Immunotherapy Outcomes in Advanced Head and Neck Cancer

“…The prognostic nutritional index (PNI), calculated by combining serum albumin and total peripheral blood lymphocyte count, is a multiparameter nutritional index developed by Onodera et al [ 12 ]. Although the PNI was originally established to assess the relationship between baseline nutritional status and postoperative complications in cancer patients undergoing gastrointestinal surgery [ 12 ], the index was shown to predict outcomes in head and neck cancer patients treated with chemotherapy or radiotherapy, or both [ 11 , 13 , 14 , 15 , 16 , 17 ]. However, the association between the PNI and immunotherapy outcomes is not well established.…”