Baseline weight recovery and mortality risk in head and neck cancer

IF 2.3 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2024-07-30 DOI:10.1002/hed.27898

Amanda J. Bastien MD, Luv Amin BS, Missael Vasquez BA, Iris Cong PhD, Michael Luu MPH, Meghan Laszlo RD, Saori Yen RD, Heather Thompson SLP, Elana L. Teitelbaum SLP, Julie K. Jang MD PhD, Alain C. Mita MD, Kevin S. Scher MD, Justin Moyers MD, Jon Mallen-St. Clair MD, PhD, Evan S. Walgama MD, Zachary S. Zumsteg MD, Allen S. Ho MD

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引用次数: 0

Abstract

Background

As a surrogate of malnutrition, degree of weight loss and recovery from head and neck cancer (HNC) treatment is understudied. The influence of modifiable factors that affect weight, including speech/language pathology (SLP) and nutrition counseling, is also poorly defined. We characterize weight loss trends, baseline weight recovery (BWR), and the impact of interdisciplinary care on oncologic outcomes.

Methods

Retrospective cohort study assessing 266 newly diagnosed patients with HNC who completed curative-intent radiation (definitive or adjuvant) between January 2016 to January 2022. Relevant treatment factors were analyzed using multivariable Cox regression models.

Results

Altogether, 266 patients completed full-course radiation therapy (RT), encompassing definitive chemoRT (53.0%), surgery with chemoRT (18.4%), surgery with RT (17.7%), and RT alone (10.9%). Patient weight reached a nadir at median 3.0 months (IQR 3.0–11.3) after radiation, with a median weight loss of 12.6% (IQR 7.9–18.7). Notably, only 47.4% exhibited BWR. For those who recovered, median time to BWR was 10.5 months (IQR 3.0–24.0). On multivariable analysis, BWR by 6 months was significantly associated with overall survival (HR 0.28 [95% CI 0.10–0.76], p = 0.013), as was SLP consultation (HR 0.40 [95% CI 0.17–0.92], p = 0.031) and nutrition consultation (HR 0.34 [95% CI 0.13–0.89], p = 0.028).

Conclusion

A high proportion of patients with HNC fail to recover baseline weight after treatment; those that do can take longer than expected to return. Failure to recover baseline weight is associated with a notable decrease in survival. Similarly, SLP and nutrition consultation are independent, modifiable determinants correlated with outcomes, supporting the emphasis on multidisciplinary management. Measures to promote BWR may reduce mortality.

查看原文本刊更多论文

头颈癌患者的基线体重恢复与死亡风险。

背景：作为营养不良的替代指标，头颈癌（HNC）治疗后的体重减轻程度和恢复情况尚未得到充分研究。包括言语/语言病理学（SLP）和营养咨询在内的影响体重的可调节因素的影响也未得到充分界定。我们对体重减轻趋势、基线体重恢复（BWR）以及跨学科护理对肿瘤治疗结果的影响进行了描述：回顾性队列研究评估了 2016 年 1 月至 2022 年 1 月期间完成治愈性放射治疗（根治性或辅助性）的 266 例新诊断 HNC 患者。采用多变量考克斯回归模型对相关治疗因素进行了分析：共有266名患者完成了全疗程放疗（RT），包括最终化疗RT（53.0%）、手术加化疗RT（18.4%）、手术加RT（17.7%）和单纯RT（10.9%）。患者体重在放疗后中位 3.0 个月（IQR 3.0-11.3）达到最低点，中位体重减轻 12.6%（IQR 7.9-18.7）。值得注意的是，只有 47.4% 的患者表现出 BWR。在恢复的患者中，中位体重减轻时间为 10.5 个月（IQR 3.0-24.0）。多变量分析显示，6 个月前的 BWR 与总生存率显著相关（HR 0.28 [95% CI 0.10-0.76]，p = 0.013），SLP 咨询（HR 0.40 [95% CI 0.17-0.92]，p = 0.031）和营养咨询（HR 0.34 [95% CI 0.13-0.89]，p = 0.028）也与总生存率显著相关：结论：很高比例的 HNC 患者在治疗后无法恢复基线体重；恢复基线体重所需的时间可能比预期的要长。未能恢复基线体重与生存率显著下降有关。同样，SLP 和营养咨询是与疗效相关的独立、可改变的决定因素，支持对多学科管理的重视。促进基础体重恢复的措施可降低死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.