Survival Analysis Three-year Follow-up of Pa­cients with Head and Neck Cancer


Authors: E. Malá 1;  E. Vejražková 2;  M. Vošmik 3;  J. Novosad 1;  L. Sobotka 4
Authors‘ workplace: Ústav klinické imunologie a alergologie, FN Hradec Králové 1;  IV. interní hematologická klinika LF UK a FN Hradec Králové 2;  Klinika onkologie a radioterapie LF UK a FN Hradec Králové 3;  III. interní gerontometabolická klinika LF UK a FN Hradec Králové 4
Published in: Klin Onkol 2016; 29(1): 39-51
Category: Original Articles
doi: 10.14735/amko201639

Overview

Background:
Patients with head and neck cancer are predominantnly at the risk for malnutrition. Monitoring of nutritional status and pre-treatment variables can favorably observe many prognostic indicators for overall survival in head and neck cancer before and during oncological treatment up to three years in head and neck cancer pacients.

Materials and Methods:
In 726 patients diagnosed head and neck cancer patients with curative intent, were collected data according to the monitoring scheme of observation. As a clinical important of uninteded weight loss was defined weight loss ≥ 10% in input (T0). Differences in groups were analysed by Cox’s regression with adjustments for important demografic and tumor-related data.

Results:
The acceptanceof the percutaneous endoscopic gastrostomy was a key factorfor less complications andto improvetoleranceof anticancer treatment. Men-smokers have the highestrisk of cardiovascular mortality. Men-stop-smokers have the most significant life extension of 11 to 22 months; p < 0.007. Men-non-smokers have a life extension of 15 to 23 months (p < 0.005) and having its lowest cardiovascular mortality (11%). Women tolerate cancer better, have minor subjective complaints and a lower number of complications but significantly higher consumption of antidepressants (p < 0.003). While men have higher analgesic consumption (p < 0.001). Weight loss > 10% significantly correlates with the clinical manifestations of malnutrition and isassociated with an increasein complications and mortality dependent cancer (p < 0.008).

Conclusion:
Consistent assessment of nutritional status with early interventionis considered as an essential part of comprehensive anticancer treatment. An independent risk factor for cancer-dependent mortality is considered weight loss of > 5% with a BMI < 21 at time T0 or weight loss > 10% weight T0 in BMI 21– 29 and continuing weight loss toT12 and also BMI ≥ 30. The highest-risk profile has a male sex-smoker, age > 63, hypopharyngeal carcinoma, stage III– IV, weight loss of > 10% and non-acceptance of percutaneous endoscopic gastrostomy. Another long-term observation of monitored nutritional status with intervention, clinical status and quality of life are needed.

Key words:
survival analysis –  head and neck cancer –  HNC –  malnutrition –  weight loss

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted:
17. 7. 2015

Accepted:
20. 9. 2015


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