title: Critical weight loss predicts poor prognosis in nasopharyngeal carcinoma.
abstract: BACKGROUND
  The impacts of weight loss on prognosis in nasopharyngeal carcinoma (NPC) remain unclear. The present study was therefore undertaken to investigate the association between critical weight loss and long-term survival in NPC patients.
  
  
  METHODS
  The eligible 2399 NPC patients were reviewed. Weight change was categorized into critical weight loss (CWL) and non-critical weight loss (Non-CWL). The associations of CWL with long-term survival were analyzed by Cox regression in the entire patient and two subsets. Propensity score matching was performed to reduce the effects of confounding factors.
  
  
  RESULTS
  CWL was defined as body weight loss of ≥4.6 %. Compared with patients without CWL, patients with CWL had significantly lower 5-year OS (72.4 vs. 79.3 %, P < 0.001), FFS (71.1 vs. 78.4 %, P <0.001), and LR-FFS (78.1 vs. 84.8 %, P <0.001), respectively. After adjustment for potential confounders, CWL remained an independence prognostic factor for OS (HR = 1.352; 95 % CI 1.160-1.576; P < 0.001), FFS (HR = 3.275; 95 % CI 1.101-9.740; P = 0.033), and LR-FFS (HR = 6.620; 95 % CI 2.990-14.658; P < 0.001), respectively. Furthermore, subgroup analysis in the cohort of patients received concurrent chemoradiotherapy or radiotherapy alone confirmed the results in the entire patient even after the propensity-score matching. In IMRT cohort, CWL was also significantly associated with a lower OS (P = 0.04) and FFS (P = 0.04).
  
  
  CONCLUSIONS
  CWL has a significant and independent impact on long-term survival in nasopharyngeal carcinoma patients.
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. Justin.zeng@foxmail.com.|Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China. Justin.zeng@foxmail.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zeng
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. shenlj@sysucc.org.cn.|Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China. shenlj@sysucc.org.cn.
authors.forename: Lu-Jun
authors.initials: LJ
authors.lastname: Shen
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. guoxiang@sysucc.org.cn.|Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China. guoxiang@sysucc.org.cn.
authors.forename: Xiang
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Pharmacy, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000, PR China. woshiming1984@163.com.
authors.forename: Xin-Ming
authors.initials: XM
authors.lastname: Guo
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. qianchn@sysucc.org.cn.|Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China. qianchn@sysucc.org.cn.
authors.forename: Chao-Nan
authors.initials: CN
authors.lastname: Qian
authors.affiliation: State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. gqw_sysucc@foxmail.com.|Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China. gqw_sysucc@foxmail.com.
authors.forename: Pei-Hong
authors.initials: PH
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult