Inflammation Status and Body Composition Predict Two-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma under Provision of Recommended Energy Intake during Concurrent Chemoradiotherapy

Abstract

Only few prospective cohort trials have evaluated the risk factors for the 2-year mortality rate between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC): oral cavity cancer with adjuvant concurrent chemoradiotherapy (CCRT) (OCC) and non-oral cavity cancer with primary CCRT (NOCC), under the recommended calorie intake and investigated the interplay among calorie supply, nutrition–inflammation biomarkers (NIBs), and total body composition change (TBC), as assessed using dual-energy X-ray absorptiometry (DXA). Patients with LAHNSCC who consumed at least 25 kcal/kg/day during CCRT were prospectively recruited. Clinicopathological variables, blood NIBs, CCRT-related factors, and TBC data before and after treatment were collected. Factor analysis was performed to reduce the number of anthropometric and DXA-derived measurements. Cox proportional hazards models were used for analysis. We enrolled 123 patients with LAHNSCC (69 with OCC and 54 with NOCC). The mean daily calorie intake correlated with the treatment interval changes in total body muscle and fat. Patients consuming ≥30 kcal/kg/day had lower pretreatment levels but exhibited fewer treatment interval changes in anthropometric and DXA measurements than patients consuming <30 kcal/kg/day. In the multivariate analysis of the 2-year mortality rate, the prognostic influence of the recommended calorie intake could not be confirmed, but different risk factors (performance status, pretreatment platelet-to-lymphocyte ratio, and treatment interval body muscle changes in patients with OCC; age, pretreatment neutrophil-to-lymphocyte ratio, and body fat storage in patients with NOCC) showed independent effects. Therefore, the inflammation status and body composition, but not the recommended calorie supply, contribute to the 2-year mortality rate for patients with LAHNSCC receiving CCRT.

Pretreatment Glasgow Prognostic Score Correlated with Serum Histidine Level and Three-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma and Optimal Performance Status

“…Additionally, aggregate parameters (PG-SGA, integrating BWL-BMI grading) may offset their values in prognosis prediction because of either data recall bias or insufficient analysis of specific cancer stages [ 4 , 59 ]. Furthermore, although body composition parameters generated from DXA or computerized tomography provide a close understanding of muscle, fat, and other tissues that could correspond to nutrition and inflammation status and correlated the prognosis of patients with LAHNSCC receiving CCRT [ 19 , 21 ], cost and inconvenience limit their clinical application. In this context, GPS offers two advantages in clinical practice: ease of use with low cost and simultaneous reflection of the systematic nutritional and inflammatory status of patients with cancer [ 60 ].…”

“…Certain clinicopathologic variables, nutrition-inflammation biomarkers (NIBs), and body composition parameters can assess pretreatment malnourished status, reflect the severity of systemic inflammation, and predict the outcomes of patients with HNC [ 13 , 14 , 15 ]. These include old age [ 14 ], comorbidity [ 14 , 15 ], poor performance status [ 13 , 14 ], low body mass index (BMI) and body weight (BW) [ 13 , 14 , 16 ], anemia [ 14 , 15 ], low total lymphocyte count [ 13 ], low prognostic nutritional index (PNI) [ 17 ], high levels of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) [ 18 , 19 , 20 ], and total muscle and fat mass [ 19 , 21 ]. In particular, the Glasgow prognostic score (GPS), an inflammation-based model that combines the levels of serum albumin and CRP, has demonstrated significance for predicting outcomes in patients with HNC under different clinical circumstances [ 22 , 23 , 24 , 25 , 26 ].…”

Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision

“…We observed a significant loss in lean body muscle (LBM) and total fat mass (TFM) in patients with LAHNSCC during CCRT [39,40]. Additionally, the pretreatment level and treatment-interval changes in TBC are associated with increased treatment-related toxicity, early treatment failure, recurrence-free survival, and two-year mortality rate among LAHNSCC patients undergoing CCRT [39][40][41][42]. Therefore, further research is needed to investigate the effect of TBC changes on treatment interruption in patients with LAHNSCC undergoing CCRT.…”

Body composition parameters were associated with response to abiraterone acetate and prognosis in patients with metastatic castration‐resistant prostate cancer

“…Recently, the role of body composition on the prediction of therapeutic efficacy and cancer prognosis has been increasingly recognized. 12 , 13 For example, our previous study revealed that preoperative lower relative visceral fat area was a vital independent predictor of response to intravesical Bacillus Calmette‐Guerin immunotherapy and was associated with preferable prognosis in patients with non‐muscle invasive bladder cancer. 12 Sarcopenia, characterized by progressive and generalized loss of skeletal muscle mass and strength, was showed to be associated with PSA progression in mHSPC patients receiving early docetaxel or AA treatment.…”

“…Recently, the role of body composition on the prediction of therapeutic efficacy and cancer prognosis has been increasingly recognized 12,13 . For example, our previous study revealed that preoperative lower relative visceral fat area was a vital independent predictor of response to intravesical Bacillus Calmette‐Guerin immunotherapy and was associated with preferable prognosis in patients with non‐muscle invasive bladder cancer 12 .…”