Higher Risk of Recurrence in Patients Treated for Head and Neck Cancer with Low BMI and Elevated Levels of C-Reactive Protein

Abstract

This prospective study identifies high-risk groups for recurrence of head and neck cancer by BMI and circulating inflammatory response markers. Head and neck cancer patients from three Swedish hospitals were included (n = 272). Leukocyte and thrombocyte counts, CRP levels, and BMI were measured pre-treatment and post-treatment. Associations between the four factors and treatment failure (residual tumor, loco-regional failure, general failure/distant metastasis) were assessed using a Cox proportional hazards model adjusted for sex, age at the initial visit, smoking status, cancer stage, and hemoglobin count. CRP level was the only significant single variable, with an average increase in risk of recurrence of 74% (p = 0.018) for every doubling. The predictive power of a combined model using all variables was highest during the initial months after treatment, with AUC under the ROC curve 0.75 at the 0–3 month timepoints. Patients with elevated pre- and post-treatment CRP levels are at higher risk for recurrence of disease. Male patients with low post-treatment BMI, advanced stage, and high CRP at any time post treatment are at high risk for recurrence. The combined model may be useful for stratifying post-treatment patients into low and high-risk groups, to enable more detailed follow-up or additional treatment regimens.

Host-related indexes in head and neck cancer

“…Another parameter, which is not always included in lab tests, and which is also a marker of a proinflammatory status, is the reactive C protein (RCP). Both of these parameters, are unspecific, which could justify why the studies have not reached a consensus on them [16,17,33].…”

“…Multiple authors have shown how patient variables such as age and comorbidities can influence outcomes [1,2]. But interestingly, there has been an increasing interest in using peripheral blood factors such as leukocytes, albumin or hemoglobin as surrogates of the host status in head and neck cancer patients [3–9,10 ▪▪ ,11 ▪▪ ,12,13 ▪▪ ,14–22]. Generally, these variables are gathered prior to treatment initiation.…”