Prognostic value of body mass index before treatment for laryngeal squamous cell carcinoma

Chemoradiotherapy vs radiotherapy for non-surgical locally advanced laryngeal squamous cell carcinoma patients: a propensity score-matched study and practical nomogram construction

OBJECTIVE

To compare the cancer-specific survival (CSS) among patients with locally advanced laryngeal squamous cell carcinoma (LSCC) receiving chemoradiotherapy (CRT) and radiotherapy (RT) treatment, as well as to establish a prognostic nomogram for survival prediction in patients receiving CRT.

METHOD

Using data from the Surveillance, Epidemiology, and End Results (SEER) database, patients with laryngeal cancer were identified between 2010 and 2015, with follow-up up to 2018. Propensity score matching (PSM) was performed to minimize disproportionate distributions of the potential confounding. Cox regression models were used to evaluate the CSS of two treatment groups. A prognostic nomogram for patients receiving CRT was then developed and evaluated.

RESULTS

Totally 1085 non-surgical patients with locally advanced LSCC were included in this study (median [IQR] age, 62 [55-69] years; 829 [76.41%] males), of which 913 receiving CRT and 172 receiving RT. After PSM, significantly improved CSS was observed in locally advanced LSCC patients receiving CRT when compared to RT (HR: 0.62 [95% CI 0.42-0.92]; P = 0.014). Then, in the group of 639 locally advanced LSCC patients receiving CRT, a prognostic nomogram based on age, tumor size, N category, and marital status were developed and validated, of which the predictive performance was superior to that of TNM staging system (7th edition).

CONCLUSION

CSS shows a statistically significant improvement in locally advanced LSCC patients who receipt of CRT when compared with RT. Furthermore, a prognostic nomogram for locally advanced LSCC patients receiving CRT was established, which shows a good calibration and identification accuracy.

The Impact of Pretreatment Low Body Mass Index on Cause-Specific Mortality in Patients with Squamous Cell Carcinoma of the Oral Cavity

The association between the pretreatment body mass index (BMI) and oral squamous cell carcinoma (SCC) outcomes is controversial. We aimed to examine the association between BMI and cause-specific mortality due to cancer of the oral cavity and patterns of failure that correlate with increased mortality. We enrolled 2,023 East Asian patients in this multicenter cohort study. We used the cumulative incidence competing risks method and the Fine-Gray model to analyze factors associated with cause-specific mortality, local recurrence, regional metastasis, and distant metastasis as first events. The median follow-up period was 62 mo. The 5-year cause-specific mortality for patients with underweight was 25.7%, which was significantly higher than that for patients with normal weight (12.7%, P < 0.0001). The multivariate model revealed that underweight was an independent risk factor for cause-specific mortality and regional metastasis (P < 0.05). Moreover, patients with underweight displayed a 51% and 55% increased risk of cause-specific mortality and regional metastasis, respectively, compared with their normal weight counterparts. Local recurrence was not associated with the BMI categories; however, the incidence of distant metastasis inversely decreased with BMI value. In summary, being underweight at diagnosis should be considered a high-risk mortality factor for oral SCC.

Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy

The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.

Body Mass Index Alters the Predictive Value of the Neutrophil-to-Lymphocyte Ratio and Systemic Inflammation Response Index in Laryngeal Squamous Cell Carcinoma Patients

Laryngeal squamous cell carcinoma (LSCC) is a frequent cancer subtype among head and neck cancers. Exacerbated inflammation and nutritional deficit are common features in this type of cancer and can be used as a prognostic marker. This study aimed to investigate the relationship between body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) on overall survival (OS) of LSCC patients. In this retrospective cohort study, 168 patients were followed for 5 years. Data on clinical factors, patients' life habits, height, weight, and hematological parameters were collected. BMI, NLR, and SIRI were calculated. Pretreatment NLR≥ 2.02 and SIRI≥ 1160.85 were independent prognostic factors for poor OS. Low BMI did not significantly affect the OS. However, the inflammatory parameters had their predictive capacity altered when stratified by the BMI classification. NLR≥ 2.02 + Low BMI or SIRI≥ 1160.85 + Low BMI increased in 8.6 and 3.8 times the risk of death, respectively. In contrast, stratification by normal/high BMI classification eliminated the predictive capacity of NLR and SIRI. Here, we demonstrated the possible ability of BMI to change the prognostic capacity of inflammatory markers NLR and SIRI in patients with LSCC.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1952447.

Evaluation of Risk Factors for Laryngeal Squamous Cell Carcinoma: A Single-Center Retrospective Study

Background

The survival rate of patients with laryngeal squamous cell carcinoma (LSCC) is correlated with several factors. However, the independent prognostic factors of patients with LSCC remain unclear. Thus, we sought to identify prognostic factors affecting LSCC outcomes in the Chinese population.

Methods

The survival and potential prognostic factors of 211 patients with LSCC between April 2011 and July 2019 were retrospectively analyzed. Overall survival (OS) and progression free survival (PFS) were estimated by the Kaplan Meier method, and a log-rank test was used to compare the possible prognostic factors between different groups. The Cox proportional hazard model was used to perform multivariable analysis of significant covariants.

Results

A total of 211 LSCC patients were included, of which 164 (77.7%) were male and 47 (22.3%) were female. Mean age was 62.19 ± 8.328 years. A univariate analysis showed that seven factors including pathological differentiation, clinical stage, tobacco consumption, alcohol consumption, T stage, N stage, and concurrent chemoradiotherapy were correlated with survival (P<0.05). Cox proportional hazards regression analyses revealed that clinic stage (hazard ratio=3.100, p=0.048), pathological differentiation (hazard ratio = 2.538, p=0.015), alcohol consumption (hazard ratio = 8.456, p =0.004) were associated with OS in LSCC. Pathological differentiation (hazard ratio =5.677, p=0.000), alcohol consumption (hazard ratio =6.766, p=0.000) were associated with PFS in LSCC.

Conclusions

Pathological differentiation, alcohol consumption, are independent prognostic factors and predictors of recurrence in LSCC. These factors could help inform guidelines for clinical treatment and prognosis.

Perspective: Do Fasting, Caloric Restriction, and Diets Increase Sensitivity to Radiotherapy? A Literature Review

Caloric starvation, as well as various diets, has been proposed to increase the oxidative DNA damage induced by radiotherapy (RT). However, some diets could have dual effects, sometimes promoting cancer growth, whereas proposing caloric restriction may appear counterproductive during RT considering that the maintenance of weight is a major factor for the success of this therapy. A systematic review was performed via a PubMed search on RT and fasting, or caloric restriction, ketogenic diet (>75% of fat-derived energy intake), protein starvation, amino acid restriction, as well as the Warburg effect. Twenty-six eligible original articles (17 preclinical studies and 9 clinical noncontrolled studies on low-carbohydrate, high-fat diets popularized as ketogenic diets, representing a total of 77 patients) were included. Preclinical experiments suggest that a short period of fasting prior to radiation, and/or transient caloric restriction during treatment course, can increase tumor responsiveness. These regimens promote accumulation of oxidative lesions and insufficient repair, subsequently leading to cancer cell death. Due to their more flexible metabolism, healthy cells should be less sensitive, shifting their metabolism to support survival and repair. Interestingly, these regimens might stimulate an acute anticancer immune response, and may be of particular interest in tumors with high glucose uptake on positron emission tomography scan, a phenotype associated with poor survival and resistance to RT. Preclinical studies with ketogenic diets yielded more conflicting results, perhaps because cancer cells can sometimes metabolize fatty acids and/or ketone bodies. Randomized trials are awaited to specify the role of each strategy according to the clinical setting, although more stringent definitions of proposed diet, nutritional status, and consensual criteria for tumor response assessment are needed. In conclusion, dietary interventions during RT could be a simple and medically economical and inexpensive method that may deserve to be tested to improve efficiency of radiation.

Prognostic factors in laryngeal squamous cell carcinoma

BACKGROUND

The current treatment results of laryngeal squamous cell carcinoma still remain modest. Various prognostic factors have been investigated and need to be included in the management decision making.

METHODS

We reviewed the pertinent literature regarding host, tumor, and treatment factors as prognostic indicators that influence outcome in patients diagnosed with laryngeal squamous cell carcinoma.

RESULTS

Host, tumor, and treatment factors all have an important impact upon an individual patient's prognosis with laryngeal squamous cell carcinoma, whereas staging systems only take into account tumor factors. There is much work yet to be done to establish reliable, independent biomarkers that predict survival and response to treatment.

CONCLUSIONS

Optimal outcomes for an individual patient can be achieved when taking into account tumor, host, and treatment factors.

Prognostic factors in patients with T1 glottic cancer treated with radiotherapy

PURPOSE

Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors.

METHODS

We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14-145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients.

RESULTS

The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients' age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS.

CONCLUSIONS

Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.

The Impact of Preoperative Low Body Mass Index on Postoperative Complications and Long-term Survival Outcomes in Gastric Cancer Patients

PURPOSE

The aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer.

MATERIALS AND METHODS

A total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (≤18.5 kg/m2, n=51), normal BMI group (18.6-24.9 kg/m2, n=308), and high BMI group (≥25.0 kg/m2, n=151).

RESULTS

There were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P<0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186-154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644-16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383-212.940; P=0.027).

CONCLUSIONS

Preoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.

Clinical Value of Nutritional Status in Cancer: What is its Impact and how it Affects Disease Progression and Prognosis?

Malnutrition is a common finding in cancer patients, which can affect disease progression and survival. This review aims to critically summarize the prognostic role of nutritional status, from Body Mass Index (BMI) and weight loss to nutrition screening tools and biochemical indices, in cancer patients. According to the currently available data, Prognostic Nutritional Index (PNI) was a significant prognostic factor of patients' survival, both in univariate and multivariate analyses. Pre-operative albumin was also correlated with worse outcomes, being an independent prognostic factor of survival in several studies. BMI was also well-studied, with contradictory results. Although, lower BMI was found to be an independent prognostic factor of shorter survival in some studies, in others it did not have an impact on survival. In this aspect, this review highlights the significant prognostic role of nutritional status in the disease progression and survival of cancer patients. Further, good-quality prospective studies are needed in order to draw precise conclusions on the prognostic role of specific nutritional assessment tools, and biochemical indices associated with the nutritional status in more cancer types, such as liver, breast and prostate cancer, and hematological malignancies.

Gene polymorphisms are associated with clinical outcome in Chinese resected laryngeal carcinoma patients

We examined the multigenetic index on the progression of laryngeal carcinoma in Chinese population. This study aims to assess the effects of single nucleotide polymorphisms (SNPs) on survival of Laryngeal Carcinoma (LC) patients. Eighteen SNPs were selected and genotyped using the Sequenom iPLEX genotyping system in a cohort of 170 resected Chinese LC patients. Multivariate Cox proportional hazards model and Kaplan-Meier curve were used for the prognosis analysis. Overall, the median survival time (MST) was 38.00 months. The one, three and five year Kaplan-Meier survival rate was 0.847 ± 0.028, 0.572 ± 0.038 and 0.471 ± 0.041 respectively. The risks of death with the Hazard Ratio (HR) [95% confidence intervals] (CI) of 2.40 (1.15–4.50), 2.17 (1.45–3.25), 2.39 (1.58–3.62), 3.29 (2.10–5.18), respectively. There was significant associations between the SNPs and OS when the entire study population was examined. The rs1321311 TG genotype (vs.GG), rs2494938 AA genotype (vs. GG) and rs9363918 TG genotype (vs. GG) were associated with a worse prognosis for OS (adjusted HR = 1.64; 95%confidence interval = 1.07–2.51; P = 0.022, adjusted HR = 2.85; P =0.12; adjusted HR = 1.78; P = 0.009; respectively).

The results suggest for the first time that these gene polymorphisms may serve as an independent prognostic marker for LC patients.