Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival.
BACKGROUND
Plasma arginine concentrations are lower in patients with cancer, which indicates that arginine metabolism may be disturbed in these patients. Arginine supplementation has been associated with positive effects on antitumor mechanisms and has been shown to reduce tumor growth and to prolong survival. Furthermore, the prognosis of patients with head and neck cancer remains disappointing. Insufficient intake frequently leads to malnutrition, which contributes to high morbidity and mortality rates.


OBJECTIVE
The aim of this study was to assess the long-term effects of perioperative arginine supplementation in severely malnourished patients with head and neck cancer.


METHODS
In this double-blind, randomized, controlled trial, we randomly assigned 32 severely malnourished patients with head and neck cancer to receive 1) standard perioperative enteral nutrition (n = 15) or 2) arginine-supplemented perioperative enteral nutrition (n = 17). The primary outcome was long-term (≥10 y) survival. Secondary outcomes included the long-term appearance of locoregional recurrence, distant metastases, and second primary tumors.


RESULTS
No significant differences in baseline characteristics were observed between groups. The group receiving arginine-enriched nutrition had a significantly better overall survival (P = 0.019) and better disease-specific survival (P = 0.022). Furthermore, the arginine-supplemented group had a significantly better locoregional recurrence-free survival (P = 0.027). No significant difference in the occurrence of distant metastases or occurrence of a second primary tumor was observed between the groups.


CONCLUSIONS
Perioperative arginine-enriched enteral nutrition significantly improved the long-term overall survival and long-term disease-specific survival in malnourished patients with head and neck cancer.
Buijs
Nikki
N
Department of Surgery, VU University Medical Center, MB Amsterdam, Netherlands.
van Bokhorst-de van der Schueren
Marian A E
MA
Langius
Jacqueline A E
JA
Leemans
C Rene
CR
Kuik
Dirk J
DJ
Vermeulen
Mechteld A R
MA
van Leeuwen
Paul A M
PA
D000368:Aged; D001120:Arginine / Q000627:therapeutic use*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D019990:Perioperative Care; D055502:Secondary Prevention; D016019:Survival Analysis; D013997:Time Factors
D001120:Arginine