Impact of obesity on outcomes for patients with head and neck cancer

Hicks, Daniel F.; Bakst, Richard L.; Doucette, John; Kann, Benjamin H.; Miles, Brett A.; Genden, Eric M.; Misiukiewicz, Krzysztof; Posner, Marshall R.; Gupta, Vishal

doi:10.1016/j.oraloncology.2018.05.027

Cited by 36 publications

(29 citation statements)

References 31 publications

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“…In the current study, age, male gender, smoking, and drinking history were the main risk factors for SCCHN; however, the HPV infection rate was only 3.09%. This finding is different from previous research, [15][16][17] and HPV-16 infection is excluded from the high-risk factors. These differences may be related to the primarily rural background of the enrolled patients, and the differences in their lifestyles from those of patients in developed countries.…”

Section: Discussioncontrasting

confidence: 99%

“…Surprisingly, we did not find any difference in preoperative weight loss (P=0.264) between the three groups. Laryngeal (20.12%) and tongue (14.86%) cancer were the two most common types of SCCHN, as previously reported (15), but there were no differences in the primary sites between the three groups (P=0.320) ( Table 2). The operation duration for 233 patients (72.14%) was more than 4 h, and 191 patients had intraoperative blood loss greater than 400mL.…”

Section: Resultssupporting

confidence: 78%

“…9,10 At present, most research on obesity in the field of head and neck surgery focuses on obstructive sleep apnea syndrome, 11,12 few studies have reported on head and neck squamous cell carcinoma (SCCHN). Iyengar et al 13,14 found that BMI is an independent variable affecting the prognosis of early tongue cancer, and that obese patients have a poor prognosis; these findings differ from the results reported by Hicks et al 15 In our clinical practice, we found that the incidence of complications such as pharyngeal fistula, mouth floor fistula, lung infection, fat liquefaction, and lower extremities deep venous thrombosis (LEDVT) in obese patients is greater than in patients at a healthy weight. These factors directly affect prognosis and quality of life.…”

Section: Introductioncontrasting

confidence: 87%

“…Some researchers have reported different or even opposing conclusions regarding the relationship between BMI and SCCHN prognosis. McRackan et al 18 found that SCCHN patients undergoing chemoradiotherapy with a BMI greater than 25 kg/m 2 had better RFS and total OS than patients with a BMI of 25 kg/m 2 or less, which is similar to the results reported by Hicks et al 15 and different from those of Iyengar et al [13][14][15] Iyengar et al 13,14 found that obesity is an unfavorable independent prognostic variable for early tongue cancer and is associated with DSS but does not affect OS and RFS. This association may not have been previously recognized.…”

Section: Discussionsupporting

confidence: 62%

“…studies. 15,17,18 However, in terms of BMI, no significant difference was found in the groups, through either Cox univariate or multivariate analysis, which is different from the results of Iyengar et al 13,14 In summary, with increasing BMI, the probability of complications such as pharyngeal fistula increases; BMI had no significant correlation with 3-year OS, RFS and DSS, and was not a prognostic indicator for patients with SCCHN. Although the present sample size was acceptable for the current study, it was still too small for the assessment of a single sub-group, such as gingival cancer or hypopharyngeal carcinoma patients, and the follow-up time was relatively short.…”

Section: Discussionmentioning

confidence: 66%

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<p>Influence of Body Mass Index on Survival and Prognosis in Squamous Cell Carcinoma of Head and Neck</p>

Li¹,

Liyan²,

Sun³

2020

CMAR

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Objective: Differences in body mass index (BMI) were used to analyze the survival and prognosis of SCCHN patients. Patients and Methods: A retrospective cohort study was conducted to select 323 patients who underwent surgical treatment for SCCHN from June 2013 to June 2016. The patients were divided into a healthy BMI group (BMI<24kg/m 2), an overweight group (24kg/m 2-≤BMI<28kg/m 2) and an obese group (BMI≥28 kg/m 2). Various statistical methods were used to summarize and analyze clinical data, complications, disease specific survival (DSS), the overall survival (OS), and recurrence-free survival (RFS) within the last 3 y. Results: At 3 y, OS (54.40%) and DSS (51.94%) were slightly lower in the obese group compared with the overweight (64.62%, 61.92%) and healthy BMI groups (64.66%, 65.02%), but no statistical significance was found in DSS (P=0.178), OS (P=0.123) and RFS (P=0.362). The difference in operation duration (P=0.008) and bleeding volume (P=0.001) in obese patients was consistent with those in diabetes mellitus (P=0.002) and coronary heart disease (P=0.000). A high incidence of pharyngeal fistula was observed in obese (P=0.014) and overweight patients (P=0.025), but mouth floor fistula (P=0.038), lung infection (P=0.047), fat liquefaction (P=0.003) and lower extremities deep venous thrombosis (P=0.020) were only found in the obese group. Cox univariatable and multivariatable analysis showed that clinical stage, T stage, and N stage were independent prognostic factors for patients with SCCHN, which was not related to BMI. Conclusion: BMI was associated with a higher probability of complications. However, BMI had no significant correlation with 3-year OS, RFS and DSS, and was not a prognostic indicator for patients with SCCHN.

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Section: Discussioncontrasting

confidence: 99%

Section: Resultssupporting

confidence: 78%

Section: Introductioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 66%

See 3 more Smart Citations

<p>Influence of Body Mass Index on Survival and Prognosis in Squamous Cell Carcinoma of Head and Neck</p>

Li¹,

Liyan²,

Sun³

2020

CMAR

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

et al. 2023

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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 &lt; .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 &lt; .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 &lt; .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.

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

Mastrolonardo,

Llerena,

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceFor patients treated with immune checkpoint inhibitors (ICIs), recent data suggest that obesity has a beneficial effect on survival outcomes in various cancer types. Reports on this association in head and neck cancer are limited.ObjectivesTo compare overall survival (OS) to 5 years and functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with ICIs based on pretreatment body mass index (BMI).Design, Setting, and ParticipantsThis retrospective population-based cohort study used data obtained from the TriNetX Global Collaborative Network database to identify patients with HNSCC who received ICI treatment between January 1, 2012, and December 31, 2023, resulting in a total of 166 patients (83 with BMI of 20.0-24.9 [normal BMI] and 83 with BMI of ≥30.0 [obesity BMI]) after propensity score matching (PSM) for pretreatment medical comorbidities and oncologic staging.ExposureNormal BMI vs obesity BMI.Main Outcomes and MeasuresOverall survival and functional outcomes (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) were measured to 5 years after ICI treatment and compared between patients with obesity BMI and normal BMI. Additional analyses compared OS and functional outcomes in the cohort with normal BMI and cohorts with overweight BMI (25.0-29.9) and underweight BMI (&lt;20.0).ResultsAmong the 166 patients included in the PSM analysis (112 men [67.1%]; mean [SD] age, 62.9 [15.4] years), obesity BMI was associated with significantly improved OS at 6 months (hazard ratio [HR], 0.54 [95% CI, 0.31-0.96]), 3 years (HR, 0.56 [95% CI, 0.38-0.83]), and 5 years (HR, 0.62 [95% CI, 0.44-0.86]) after ICI treatment, compared with patients with normal BMI. Obesity BMI was also associated with decreased risk of gastrostomy tube dependence at 6 months (odds ratio [OR], 0.41 [95% CI, 0.21-0.80]), 1 year (OR, 0.41 [95% CI, 0.21-0.78]), 3 years (OR, 0.35 [95% CI, 0.18-0.65]), and 5 years (OR, 0.34 [95% CI, 0.18-0.65]). Obesity was also associated with decreased risk for tracheostomy dependence at 1 year (OR, 0.52 [95% CI, 0.28-0.90]), 3 years (OR, 0.45 [95% CI, 0.45-0.90]), and 5 years (OR, 0.45 [95% CI, 0.45-0.90]). There were no differences in rates of dysphagia or immune-related adverse events between cohorts at any points.Conclusions and RelevanceUsing population-level data for patients with HNSCC treated with ICIs, these results suggest that having obesity was associated with improved 6-month, 3-year, and 5-year OS compared with having normal BMI. Additionally, obesity was associated with decreased gastrostomy and tracheostomy tube dependence compared with normal BMI. Further investigation is required to understand the mechanism of these findings.

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Impact of obesity on outcomes for patients with head and neck cancer

Cited by 36 publications

References 31 publications

<p>Influence of Body Mass Index on Survival and Prognosis in Squamous Cell Carcinoma of Head and Neck</p>

<p>Influence of Body Mass Index on Survival and Prognosis in Squamous Cell Carcinoma of Head and Neck</p>

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

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

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