Objectives: The prognostic role of obesity in head and neck squamous cell carcinoma (HNSCC) is not well defined. This study aims to determine its effect on disease-specific outcomes such as recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in addition to overall survival (OS).
Methods: For patients with newly diagnosed HNSCC undergoing radiation therapy (RT) at a single institution, body mass index (BMI) at diagnosis was categorized as normal (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2) and obese (≥30 kg/m2). Outcomes were compared by BMI group using Cox regression.
Results: 341 patients of median age 59 (range, 20-93) who underwent curative RT from 2010 to 2017 were included. 58% had oropharynx cancer, 17% larynx and 15% oral cavity. 72% had stage IVA/B disease and 28% stage I-III. At diagnosis, 33% had normal BMI, 40% overweight, and 28% obese. 59% had definitive RT and 41% had postoperative RT. Alcoholic/smoking status, advanced tumor stage, hypopharynx/larynx tumors, and feeding tube placement were more common in patients with lower BMI (P < .05 for each). Median follow-up was 30 months (range, 3-91). Higher BMI was associated with improved OS (P < .05) and obesity was associated with longer RFS (P < .05) and DMFS (P < .05), but not LRRFS (P = .07) after adjusting for confounding variables.
Conclusion: Being overweight/obese at the time of HNSCC diagnosis is an independent prognostic factor conferring better survival, while obesity is independently associated with longer time to recurrence, primarily by improving distant control.
Keywords: Body mass index; Disease control; Head and neck cancer; Obesity; Outcomes; Overall survival; Prognostic factors; Radiotherapy.
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