Pretreatment fat-free mass index correlates with early death in patients with head and neck squamous cell carcinoma

• Published in: Head & neck 2024-04, Vol.46 (4), p.808-818
• Main Authors: Talani, Charbél, Astradsson, Thorsteinn, Farnebo, Lovisa, Mäkitie, Antti, Ehrsson, Ylva Tiblom, Laurell, Göran
• Format: Article
• Language: English
• Subjects: Body mass index; Body weight; Death; Diagnosis; Head & neck cancer; Head and neck carcinoma; Laryngeal cancer; Malnutrition; Medicin och hälsovetenskap; Oral carcinoma; Oral cavity; Risk factors; Squamous cell carcinoma
• ISSN: 1043-3074; 1097-0347; 1097-0347
• DOI: 10.1002/hed.27628

A significant proportion of patients with head and neck squamous cell carcinoma (HNSCC) are malnourished at diagnosis. In this study, we investigated how pretreatment body mass index (BMI) and fat-free mass index (FFMI) correlate with early death, and whether these measurements are useful markers of prognosis for risk stratification of head and neck cancer patients. Patients (n = 404) with newly diagnosed, curable HNSCC and WHO performance status 0-2 were prospectively included and met with a study representative before treatment initiation, as well as up to four follow-up visits. All patients provided an estimate of body weight at 6 months prior to diagnosis. Bioelectrical impedance analysis (BIA) was performed for all patients before treatment initiation. Most patients had oropharyngeal (46%), oral cavity (28%), or laryngeal cancer (12%). Forty-five (11%) patients met the standardized criteria for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) at diagnosis. FFMI at diagnosis was lower in patients who died within 6 and 12 months after the start of treatment than in patients who survived these time points (p = 0.035 and p = 0.005, respectively). In this study, pretreatment FFMI was an independent prognostic factor for death within 6 and 12 months after the start of treatment in patients with HNSCC. Pretreatment BMI was not an independent risk factor for death within 6 and 12 months after treatment termination. Thus, FFMI may be useful for risk stratification of patients with head and neck cancer.