The impact of nutritional status on the prognoses of patients with advanced head and neck cancer.
BACKGROUND
Malnutrition has been recognized as a poor prognostic indicator for cancer treatment-related morbidity and mortality in general, and it is reported to affect 30-50% of all patients with head and neck cancer. In this study, the correlation of nutritional status with 3-year survival was studied prospectively in 64 patients with T2-T4 carcinomas of the head and neck who were treated surgically with curative intent; the surgery was often followed by radiotherapy.


METHODS
All patients underwent nutritional screening according to six different parameters on the day prior to surgery. Overall and disease specific survival analyses were performed with a follow-up period of at least 3 years. Survival analyses were performed with the log rank test and the Cox proportional hazards model.


RESULTS
Lymph node stage, nonradical resection margins, and occurrence of major postoperative complications were demonstrated to affect disease specific survival for the group as a whole. None of the investigated nutritional parameters were correlated with survival. When men and women were analyzed separately, however, a preoperative weight loss of >5% did have a prognostic value for men. The combination of male gender, preoperative weight loss, and major postoperative complications were related to early death.


CONCLUSIONS
Apart from the well-known prognostic parameters lymph node status (T classification) and status of surgical margins, preoperative weight loss and occurrence of major postoperative complications were also found to have a negative effect on the survival of male patients undergoing surgery for advanced head and neck cancer.
van Bokhorst-de van der Schuer
Department of Dietetics, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
van Leeuwen
P A
PA
Kuik
D J
DJ
Klop
W M
WM
Sauerwein
H P
HP
Snow
G B
GB
Quak
J J
JJ
D000704:Analysis of Variance; D016001:Confidence Intervals; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009748:Nutrition Disorders / Q000401:mortality*; D009752:Nutritional Status; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015431:Weight Loss