Age-adjusted Charlson comorbidity index as a prognostic factor of hypopharyngeal cancer treated with chemoradiation therapy.

CONCLUSION: The age-adjusted Charlson comorbidity index (ACCI) was associated with overall survival, disease-specific survival, and non-cancer death in patients treated with chemoradiation therapy (CRT) for hypopharyngeal cancer (HPC). Further studies using other CRT regimens are required. OBJECTIVE: To investigate the impact of the ACCI on survival in patients with HPC. METHODS: This study reviewed 128 patients with HPC who received CRT between 2004-2012. The survival rates and the cumulative incidence of non-cancer death according to the ACCI were estimated. A Cox proportional hazard model was used to assess the hazard ratio (HR) of the ACCI. RESULTS: The disease-specific survival rates at 3 years for the low ACCI group, moderate group, and high group were 80.1%, 45.8%, and 54.8%, respectively (p = 0.007). The laryngectomy-free survival rates at 3 years were 61%, 39.7%, and 37.1%, respectively (p = 0.137). The cumulative incidences of non-HPC death were 5% for the low/moderate ACCI group and 15.5% for the high ACCI group (p = 0.031). The HRs compared to the low ACCI group for overall survival, disease-specific survival, and laryngectomy-free survival were 2.61 and 2.74, 2.55 and 2.27, and 1.75 and 1.97 in the moderate and high ACCI groups, respectively.

Transaminase Activity Predicts Survival in Patients with Head and Neck Cancer.

Various serum biomarkers have been developed for predicting head and neck squamous cell carcinoma (HNSCC) prognosis. However, none of them have been proven to be clinically significant. A recent study reported that the ratio of aspartate aminotransaminase (AST) to alanine aminotransaminase (ALT) had a prognostic effect on non-metastatic cancers. This study aimed to examine the effect of the AST/ALT ratio on the survival of patients with HNSCC. Clinical data of 356 patients with locoregionally advanced HNSCC were collected. The effect of the AST/ALT ratio on overall survival was analyzed using a Cox proportional hazard model. Moreover, recursive partitioning analysis (RPA) was used to divide the patients into groups on the basis of the clinical stage and AST/ALT ratio. The prognostic ability of this grouping was validated using an independent data set (N = 167). The AST/ALT ratio ranged from 0.42 to 4.30 (median, 1.42) and was a prognostic factor for overall survival that was independent of age, primary sites, and tumor stage (hazard ratio: 1.36, confidence interval: 1.08-1.68, P = 0.010). RPA divided patients with stage IVA into the following two subgroups: high AST/ALT (≥2.3) and low AST/ALT (<2.3) subgroups. The 5-year survival rate for patients with stage III, stage IVA with a low AST/ALT ratio, stage IVA with a high AST/ALT ratio, and stage IVB were 64.8%, 49.2%, 28.6%, and 33.3%, respectively (p < 0.001). Compared with the low AST/ALT group, the adjusted hazard ratio for death was 2.17 for high AST/ALT group (confidence interval: 1.02-.22 P = 0.045). The AST/ALT ratio was demonstrated to be a prognostic factor of HNSCC. The ratio subdivided patients with stage IVA into low- and high-risk groups. Moreover, intensified treatment for the high-risk group may be considered.

Prognostic significance of body mass index before treatment for head and neck cancer.

BACKGROUND: Patients with head and neck cancer frequently experience malnutrition. The purpose of this study was to examine the impact of nutritional status on prognosis and its association with treatment modalities. METHODS: This retrospective study included 706 patients with head and neck cancer diagnosed between 2004 and 2012. The effects of pretreatment body mass index (BMI) on overall survival were analyzed using the Kaplan-Meier method and Cox regression model. RESULTS: BMI ranged from 11.6 to 38.0 kg/m2 (median, 21.5) and was a prognostic factor for survival, independent of primary site, and tumor stage. The 5-year survival rates for underweight, normal, and overweight groups were 32.2%, 62.7%, and 73.5%, respectively. The hazard ratios of BMI in the surgery, chemoradiation, and radiation groups were 0.95, 0.91, and 0.79, respectively, and the latter two were statistically significant. CONCLUSION: The impact of BMI is determined by the types of cancer treatment. Pretreatment BMI should be considered while deciding treatment.

Factors associated with malnutrition in patients with head and neck cancer.

CONCLUSIONS: Comorbidities as well as T classification were the primary determinants for the nutritional status of patients with head and neck cancer. OBJECTIVES: We aimed to elucidate the underlying conditions of malnutrition in patients with head and neck cancer. METHODS: We retrospectively reviewed 726 patients diagnosed with head and neck cancer between 2004 and 2013. Associations between malnutrition and clinical parameters were assessed using univariate and multivariate analyses. RESULTS: Median body mass index was 21.5 (range 11.6-38.0). According to World Health Organization criteria, the nutritional status of these patients was classified into four groups: underweight (18%), normal (63%), overweight (17%), and obese (1%). Comorbidities were detected in 40% of patients. Multivariate analysis revealed the following factors to be independent factors associated with malnutrition: advanced T stage, metachronous cancer, collagen disease, gastrointestinal disease, and pulmonary disease.