Department of Oto-Rhino-Laryngology and Head-Neck Surgery, Semmelweis University, Budapest, Hungary.
Department of Voice, Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6599-6611. doi: 10.1007/s00405-024-08865-w. Epub 2024 Aug 6.
The survival benefit with higher body mass index (BMI) of patients suffering from head and neck squamous cell carcinoma (HNSCC) is documented as BMI paradox. As the early re-nourishment of high-risk patients determine survival, we searched for a nutritional status marker suitable for everyday screening. Grouping patients based on the 8th Edition of TNM Classification, we investigated for the first time the candidate nutritional status markers among TNM8 subgroups, including the newly introduced p16 positive oropharyngeal squamous cell cancer (OPSCC) patients.
We conducted a retrospective cohort study enrolling 661 patients and collecting anthropometric indices, laboratory parameters, clinical scores, nutritional risk scores. To discover the best one for screening survival analyses and correlation tests were executed.
By performing univariate Cox regression, we found three nutritional markers significantly correlating with overall survival (OS) and cancer specific survival (CSS): BMI at diagnosis, percent of weight loss over six months and prognostic nutritional index (PNI). The latter proved to be independent of tumor stage. p16 negative OPSCC patient's OS and CSS did not correlate with BMI, but it did correlate with PNI and percent of weight loss. BMI was the only marker correlating with OS, only in stage 4 hypopharyngeal cancer patients. All three markers significantly correlated with survival among p16 positive oropharyngeal and glottic cancer patients.
We found BMI, percent of weight loss and PNI good candidate markers for malnutrition. PNI proved to be superior in every aspect, enabling the treating physicians to discover high-risk patients in need of aggressive re-nourishment. The survival of supraglottic laryngeal squamous cancer patients seemed to be independent of these nutritional status markers, which observation should be a subject of further investigations.
患有头颈部鳞状细胞癌（HNSCC）的患者，体重指数（BMI）越高生存获益越大，这种现象被称为 BMI 悖论。由于高危患者的早期再营养决定了生存，我们寻找了一种适合日常筛查的营养状况标志物。我们根据第 8 版 TNM 分类对患者进行分组，首次在 TNM8 亚组中研究候选营养状况标志物，包括新引入的 p16 阳性口咽鳞状细胞癌（OPSCC）患者。
我们进行了一项回顾性队列研究，纳入了 661 例患者，收集了人体测量指标、实验室参数、临床评分和营养风险评分。为了发现最适合筛查生存分析的标志物，我们进行了单变量 Cox 回归分析和相关性检验。
通过单变量 Cox 回归，我们发现了三个与总生存（OS）和癌症特异性生存（CSS）显著相关的营养标志物：诊断时的 BMI、6 个月内体重下降百分比和预后营养指数（PNI）。后者独立于肿瘤分期。p16 阴性 OPSCC 患者的 OS 和 CSS 与 BMI 不相关，但与 PNI 和体重下降百分比相关。BMI 是唯一与 OS 相关的标志物，仅在 4 期下咽癌患者中。所有三个标志物在 p16 阳性口咽和喉癌患者中与生存显著相关。
我们发现 BMI、体重下降百分比和 PNI 是营养不良的候选标志物。PNI 在各个方面都表现优异，使治疗医生能够发现需要积极再营养的高危患者。声门上喉鳞状细胞癌患者的生存似乎与这些营养状况标志物无关，这一观察结果应作为进一步研究的课题。
