Objective evaluation of nutritional status using the prognostic nutritional index during and after chemoradiotherapy in Japanese patients with head and neck cancer: a retrospective study

Background: The Prognostic Nutritional Index (PNI) is a parameter of nutritional and inflammation status related to toxicity in cancer treatment. Since data for head and neck cancer are scanty, this study aims to investigate the association between PNI and acute and late toxicity for this malignancy. Methods: A retrospective cohort of 179 head and neck cancer patients treated with definitive radiotherapy with induction/concurrent chemotherapy was followed-up (median follow-up: 38 months) for toxicity and vital status between 2010 and 2017. PNI was calculated according to Onodera formula and low/high PNI levels were defined according to median value. Odds ratio (OR) for acute toxicity were calculated through logistic regression model; hazard ratios (HR) for late toxicity and survival were calculated through the Cox proportional hazards model. Results: median PNI was 50.0 (interquartile range: 45.5–53.5). Low PNI was associated with higher risk of weight loss > 10% during treatment (OR = 4.84, 95% CI: 1.73–13.53 for PNI < 50 versus PNI ≥ 50), which was in turn significantly associated with worse overall survival, and higher risk of late mucositis (HR = 1.84; 95% CI:1.09–3.12). PNI predicts acute weight loss >10% and late mucositis. Conclusions: PNI could help clinicians to identify patients undergoing radiotherapy who are at high risk of acute and late toxicity.

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Pretreatment prognostic nutritional index as a prognostic marker in head and neck cancer: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-96598-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chih-Wei Luan ◽

Yao-Te Tsai ◽

Hsin-Yi Yang ◽

Kuan-Yin Chen ◽

Po-Hsien Chen ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Predictive Value ◽

Meta Analysis ◽

Prognostic Nutritional Index ◽

Cochrane Library ◽

Cancer Site ◽

Free Survival ◽

Nutritional Index

AbstractThe predictive value of the pretreatment prognostic nutritional index (PNI) for head and neck cancer (HNC) remains controversial. We conducted a meta-analysis to assess the predictive value of PNI in HNC patients. A systematic search through internet databases including PubMed, Embase, and Cochrane Library for qualified studies estimating the association of PNI with HNC patient survival was performed. Overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) data were collected and evaluated. A random-effects model was used to calculate the pooled hazard ratios (pHRs) and corresponding 95% confidence intervals (CIs). A total of 7815 HNC patients from 14 eligible studies were involved. Pooled analysis showed that low pretreatment PNI was correlated with poor OS (pHR: 1.93, 95% CI 1.62–2.30, p < 0.001), PFS (pHR: 1.51, 95% CI 1.19–1.92, p = 0.008), DSS (pHR: 1.98, 95% CI 1.12–3.50, p < 0.001), DFS (pHR: 2.20, 95% CI 1.66–2.91, p < 0.001) and DMFS (pHR: 2.04, 95% CI 1.74–2.38, p < 0.001). Furthermore, low pretreatment PNI was correlated with poor OS despite variations in the cancer site, sample size, PNI cut-off value, analysis method (multivariate analysis or univariate analysis) and treatment modality in subgroup analysis. Elevated pretreatment PNI is correlated with a superior prognosis in HNC patients and could be used as a biomarker in clinical practice for prognosis prediction and treatment stratification.

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Protein Intake, Prognostic Nutritional Index and Quality of Life in Head and Neck Cancer Patients Undergoing Radiotherapy

The Indonesian Biomedical Journal ◽

10.18585/inabj.v11i1.570 ◽

2019 ◽

Vol 11 (1) ◽

pp. 70-7

Author(s):

Andry Kelvianto ◽

Fiastuti Witjaksono ◽

Sri Mutya Sekarutami

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Protein Intake ◽

Prognostic Nutritional Index ◽

Nutritional Index ◽

Eortc Quality

BACKGROUND: It has not been well understood whether the quality and quantity of protein intake could affect the quality of life. Quality of life is associated with nutritional status, but the usage of prognostic nutritional index (PNI) to reflect quality of life of head and neck cancer patients undergoing radiotherapy also still has not been widely studied.METHODS: A cross sectional study was performed in 61 head and neck cancer patient undergoing radiotherapy. The quantity and quality of protein intake were obtained using semiquantitative food frequency questionnaire (FFQ) which was analized by analyzed using Nutrisurvey 2007, PNI was obtained using a calculation of Onodera’s formula based on laboratory data of serum albumin and total lymphocyte count (TLC), and domains of quality of life were obtained from the interview of European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and EORTC Quality of Life Head and Neck module (QLQ-H&N35) and then calculated to get each domain’s score on quality of life.RESULTS: Patient’s median of total protein intake was 1.42 (0.26-4.11) g/kg/day. The median of PNI was 45.9 (29.4- 54.2). Quantity of protein intake was significantly correlated with several symptoms domain of quality of life. PNI was also significantly correlated with one functional domain and two symptom domains of quality of life. This study did not show a significant correlation between quantity and quality of protein intake with PNI.CONCLUSION: PNI has the potential to reflect quality of life of head and neck cancer patients. Future studies might be beneficial to show the usage of PNI to reflect quality of life, especially involving the progressivity of quality of life.KEYWORDS: animal protein, chemoradiotherapy, cachexia, quality of life

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Prognostic Nutritional Index: an easy nutritional screening for patients with head and neck cancer?

ESMO Open ◽

10.1136/esmoopen-2018-000449 ◽

2018 ◽

Vol 3 (6) ◽

pp. e000449 ◽

Cited By ~ 2

Author(s):

Paolo Bossi

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Prognostic Nutritional Index ◽

Nutritional Screening ◽

Nutritional Index

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Nutritional Status as a Predictive Biomarker for Immunotherapy Outcomes in Advanced Head and Neck Cancer

Cancers ◽

10.3390/cancers13225772 ◽

2021 ◽

Vol 13 (22) ◽

pp. 5772

Author(s):

Meytal Guller ◽

Matthew Herberg ◽

Neha Amin ◽

Hosam Alkhatib ◽

Christopher Maroun ◽

...

Keyword(s):

Head And Neck Cancer ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Univariate Analysis ◽

Stage Iv ◽

Prognostic Nutritional Index ◽

Progression Free Survival ◽

Johns Hopkins Hospital ◽

Advanced Head

The association between pretreatment nutritional status and immunotherapy response in patients with advanced head and neck cancer is unclear. We retrospectively analyzed a cohort of 99 patients who underwent treatment with anti-PD-1 or anti-CTLA-4 antibodies (or both) for stage IV HNSCC between 2014 and 2020 at the Johns Hopkins Hospital. Patient demographics and clinical characteristics were retrieved from electronic medical records. Baseline prognostic nutritional index (PNI) scores and pretreatment body mass index (BMI) trends were calculated. Associations between PNI and BMI were correlated with overall survival (OS), progression-free survival (PFS), and immunotherapy response. In univariate analysis, there was a significant correlation between OS and PFS with baseline PNI (OS: HR: 0.464; 95% CI: 0.265–0.814; PFS: p = 0.007 and HR: 0.525; 95% CI: 0.341–0.808; p = 0.003). Poor OS was also associated with a greater decrease in pretreatment BMI trend (HR: 0.42; 95% CI: 0.229–0.77; p = 0.005). In multivariate analysis, baseline PNI but not BMI trend was significantly associated with OS and PFS (OS: log (HR) = −0.79, CI: −1.6, −0.03, p = 0.041; PFS: log (HR) = −0.78, CI: −1.4, −0.18, p = 0.011). In conclusion, poor pretreatment nutritional status is associated with negative post-immunotherapy outcomes.

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Nutritional status as a prognostic factor in advanced head and neck cancer

Clinical Otolaryngology ◽

10.1046/j.1365-2273.1998.0165g.x ◽

1998 ◽

Vol 23 (4) ◽

pp. 376-376

Author(s):

Quak ◽

Van Bokhorst ◽

Klop ◽

Van Leeuwen ◽

Snow

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factor ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Advanced Head

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Prognosis in Head and Neck Cancer: Importance of Nutritional and Biological Inflammatory Status

Otolaryngology ◽

10.1177/01945998211004592 ◽

2021 ◽

pp. 019459982110045

Author(s):

Nicolas Saroul ◽

Mathilde Puechmaille ◽

Céline Lambert ◽

Achraf Sayed Hassan ◽

Julian Biau ◽

...

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factors ◽

Inflammatory Response ◽

Nutritional Status ◽

Head And Neck ◽

Neck Cancer ◽

Risk Index ◽

Nutritional Risk ◽

Inflammatory Status ◽

Nutritional Risk Index

Objectives To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer. Study Design Single-center retrospective study of prospectively collected data. Setting Tertiary referral center. Methods Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival. Results In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor. Conclusion Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

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Effectiveness of nivolumab affected by prior cetuximab use and neck dissection in Japanese patients with recurrent or metastatic head and neck cancer: results from a retrospective observational study in a real-world setting

International Journal of Clinical Oncology ◽

10.1007/s10147-021-01900-4 ◽

2021 ◽

Author(s):

Shin Kariya ◽

Yasushi Shimizu ◽

Nobuhiro Hanai ◽

Ryuji Yasumatsu ◽

Tomoya Yokota ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Dissection ◽

Neck Cancer ◽

Median Overall Survival ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

Japanese Patients ◽

Free Survival

Abstract Background To examine the effect of prior use of cetuximab and neck dissection on the effectiveness of nivolumab, we conducted a large-scale subgroup analysis in Japanese patients with recurrent/metastatic head and neck cancer. Methods Data on the effectiveness of nivolumab were extracted from patient medical records. All patients were analyzed for effectiveness by prior cetuximab use. In the analyses for prior neck dissection, only patients with locally advanced disease were included. Results Of 256 patients analyzed, 155 had received prior cetuximab. Nineteen of 50 patients with local recurrence underwent neck dissection. The objective response rate was 14.7 vs 17.2% (p = 0.6116), median progression-free survival was 2.0 vs 3.1 months (p = 0.0261), and median overall survival was 8.4 vs 12 months (p = 0.0548) with vs without prior cetuximab use, respectively. The objective response rate was 23.1 vs 25.9% (p = 0.8455), median progression-free survival was 1.8 vs 3.0 months (p = 0.6650), and median overall survival was 9.1 vs 9.9 months (p = 0.5289) with vs without neck dissection, respectively. Conclusions These findings support the use of nivolumab for patients with recurrent/metastatic head and neck cancer regardless of prior cetuximab use or neck dissection history. Trial registration number UMIN-CTR (UMIN000032600), Clinicaltrials.gov (NCT03569436)

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