Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy

Kono, Takeyuki; Sakamoto, Koji; Shinden, Seiichi; Ogawa, Kaoru

doi:10.1016/j.clnu.2016.10.021

Cited by 78 publications

(52 citation statements)

References 25 publications

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“…Higher numbers of early cessation of CRT in this group also reflect this. These higher frequencies of dose-limiting toxicities are in line with previous results for LAHNSCC, 9,44,46 and other cancer types. [47][48][49] This finding demands for early identification of muscle wasting to allow personalized measures in order to obviate potential side effects of HNC treatment.…”

Section: Discussionsupporting

confidence: 92%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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Section: Discussionsupporting

confidence: 92%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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“…Studies reported cutoff values of 40-51 [34][35][36], with several studies, such as ours, defining a low PNI as below 40 [16,17,37]. Other studies have defined PNIs >50 as normal, PNIs of 45-50 as mild malnutrition, 40-45 as moderate to severe malnutrition, and <40 as serious malnutrition [38][39][40]. Kono et al reported that a PNI <40, indicative of serious malnutrition, was significantly associated with severe adverse toxicity of radiotherapy among patients with head and neck cancer [40].…”

Section: Discussionmentioning

confidence: 78%

“…Other studies have defined PNIs >50 as normal, PNIs of 45-50 as mild malnutrition, 40-45 as moderate to severe malnutrition, and <40 as serious malnutrition [38][39][40]. Kono et al reported that a PNI <40, indicative of serious malnutrition, was significantly associated with severe adverse toxicity of radiotherapy among patients with head and neck cancer [40]. Moreover, Onodera et al demonstrated that patients with a PNI <40 had a high complication rate for operations such as resection and anastomosis in gastrointestinal surgery, and that a PNI <40 was a contraindication for these procedures [15].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Hong

Suh

et al. 2020

Nutrients

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The nutritional condition of patients is an important prognostic factor in various diseases. Free flap failure is a serious complication in patients undergoing free flap reconstruction, increasing morbidity and hospital costs. We evaluated the predictive factors, including the prognostic nutritional index (PNI), associated with free flap failure in extremity reconstruction. The PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3), with a PNI <40 defined as low. Univariate and multivariate logistic regression analyses were performed to evaluate factors predictive of free flap failure. Postoperative outcomes, including duration of hospital stay and rate and duration of intensive care unit admission, were also evaluated. Of the 625 patients included, 38 (6.1%) experienced free flap failure. Multivariate logistic regression analysis revealed that predictors of free flap failure were female (odds ratio: 2.094; p = 0.031) and a low PNI (odds ratio: 3.859; p <0.001). The duration of hospital stay was significantly longer in patients who did than those who did not experience free flap failure (62.1 ± 55.5 days vs. 28.3 ± 24.4 days, p <0.001). A low PNI is associated with free flap failure, leading to prolonged hospital stay. This result suggests that the PNI can be simply and effectively used to predict free flap failure.

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“…The immune dysfunction and cytokine storm play an important role in the progression of COVID-19 patients [25,26]. In addition, CONUT has been con rmed valuable in assessing nutritional status and hence associated with outcome in various patients [27][28][29]. Malnutrition is actually a potent predictor of mortality in some viral infection such as in uenza A (H1N1) virus infection [30,31].…”

Section: Discussionmentioning

confidence: 99%

CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

Wang

Yue

et al. 2020

Preprint

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Background The coronavirus disease 2019 (COVID-19) pneumonia, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19. Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score. Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age (p < 0.001) and male ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension (p < 0.001), chronic lung disease (p = 0.001) and cardiovascular disease (p = 0.005). Complications such as respiratory failure(p < 0.001), acute kidney injury (AKI) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001). Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

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Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy

Cited by 78 publications

References 25 publications

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

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