title: Nutrition during trimodality treatment in stage III non-small cell lung cancer: not only important for underweight patients.
abstract: BACKGROUND
  Trimodality treatment for stage III non-small cell lung cancer (NSCLC), consisting of chemoradiotherapy followed by surgery, is associated with treatment-related toxicity, malnutrition, and postoperative complications. The aim of this retrospective study was to investigate the predictive value of nutritional parameters on postoperative morbidity, mortality, and survival.
  
  
  METHODS
  Patients with stage III NSCLC undergoing concurrent chemoradiotherapy followed by surgery in one center between 2003 and 2009 were included. Age, sex, forced expiratory volume in 1 second, body mass index, weight change, and surgical and pathological factors were recorded and related to the occurrence of postoperative complications/mortality, overall survival (OS), and progression-free survival.
  
  
  RESULTS
  Of 51 study patients, 17 (33%) had overweight (body mass index ≥ 25) at start of treatment and 20 patients (39%) were malnourished at hospital admission for surgery. Postoperative complications occurred in 25 patients (49%), 6 had major complications, and 2 died within 90 days after surgery, but no significant predictive factors were found. Overall, weight loss ≥5% during induction period was associated with shorter OS (p = 0.03), but especially overweight patients experiencing weight loss ≥5% during induction period (n = 7) had shorter OS (hazard ratio 4.63, p = 0.005; log-rank p = 0.04) and progression-free survival (hazard ratio 6.03, p = 0.007).
  
  
  CONCLUSIONS
  This study indicates that malnutrition especially in overweight patients negatively influences survival outcomes of trimodality treatment for stage III NSCLC.
authors.affiliation: Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: van der Meij
authors.forename: Erik C J
authors.initials: EC
authors.lastname: Phernambucq
authors.forename: Geert M
authors.initials: GM
authors.lastname: Fieten
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.forename: Paul A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.forename: J Wolter A
authors.initials: JW
authors.lastname: Oosterhuis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001835:Body Weight; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D009752:Nutritional Status; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome