Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, United States.
Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, United States.
Oral Oncol. 2018 Aug;83:11-17. doi: 10.1016/j.oraloncology.2018.05.027. Epub 2018 Jun 5.
The prognostic role of obesity in head and neck squamous cell carcinoma (HNSCC) is not well defined. This study aims to determine its effect on disease-specific outcomes such as recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in addition to overall survival (OS).
For patients with newly diagnosed HNSCC undergoing radiation therapy (RT) at a single institution, body mass index (BMI) at diagnosis was categorized as normal (18.5 to 24.9 kg/m), overweight (25 to 29.9 kg/m) and obese (≥30 kg/m). Outcomes were compared by BMI group using Cox regression.
341 patients of median age 59 (range, 20-93) who underwent curative RT from 2010 to 2017 were included. 58% had oropharynx cancer, 17% larynx and 15% oral cavity. 72% had stage IVA/B disease and 28% stage I-III. At diagnosis, 33% had normal BMI, 40% overweight, and 28% obese. 59% had definitive RT and 41% had postoperative RT. Alcoholic/smoking status, advanced tumor stage, hypopharynx/larynx tumors, and feeding tube placement were more common in patients with lower BMI (P < .05 for each). Median follow-up was 30 months (range, 3-91). Higher BMI was associated with improved OS (P < .05) and obesity was associated with longer RFS (P < .05) and DMFS (P < .05), but not LRRFS (P = .07) after adjusting for confounding variables.
Being overweight/obese at the time of HNSCC diagnosis is an independent prognostic factor conferring better survival, while obesity is independently associated with longer time to recurrence, primarily by improving distant control.
肥胖在头颈部鳞状细胞癌（HNSCC）中的预后作用尚未明确。本研究旨在确定其对疾病特异性结局的影响，如无复发生存率（RFS）、局部区域无复发生存率（LRRFS）和无远处转移生存率（DMFS），以及总生存率（OS）。
对于在单机构接受放射治疗（RT）的新诊断为 HNSCC 的患者，将诊断时的体重指数（BMI）分为正常（18.5 至 24.9 kg/m）、超重（25 至 29.9 kg/m）和肥胖（≥30 kg/m）。使用 Cox 回归比较 BMI 组的结果。
共纳入 341 例中位年龄为 59 岁（范围，20-93 岁）的患者，他们在 2010 年至 2017 年间接受了根治性 RT。58%患有口咽癌，17%患有喉癌，15%患有口腔癌。72%的患者为 IVA/B 期，28%的患者为 I-III 期。在诊断时，33%的患者 BMI 正常，40%的患者超重，28%的患者肥胖。59%的患者接受了确定性 RT，41%的患者接受了术后 RT。BMI 较低的患者更常出现酒精/吸烟状态、晚期肿瘤分期、下咽/喉肿瘤和放置喂养管（P<.05）。中位随访时间为 30 个月（范围，3-91）。在调整混杂因素后，较高的 BMI 与 OS 改善相关（P<.05），肥胖与 RFS（P<.05）和 DMFS（P<.05）更长相关，但与 LRRFS 无关（P=.07）。
HNSCC 诊断时超重/肥胖是独立的预后因素，可改善生存，而肥胖与复发时间延长独立相关，主要通过改善远处控制。
