The impact of nutritional status on the prognoses of patients with advanced head and neck cancer.

BACKGROUND: Malnutrition has been recognized as a poor prognostic indicator for cancer treatment-related morbidity and mortality in general, and it is reported to affect 30-50% of all patients with head and neck cancer. In this study, the correlation of nutritional status with 3-year survival was studied prospectively in 64 patients with T2-T4 carcinomas of the head and neck who were treated surgically with curative intent; the surgery was often followed by radiotherapy.

METHODS: All patients underwent nutritional screening according to six different parameters on the day prior to surgery. Overall and disease specific survival analyses were performed with a follow-up period of at least 3 years. Survival analyses were performed with the log rank test and the Cox proportional hazards model.

RESULTS: Lymph node stage, nonradical resection margins, and occurrence of major postoperative complications were demonstrated to affect disease specific survival for the group as a whole. None of the investigated nutritional parameters were correlated with survival. When men and women were analyzed separately, however, a preoperative weight loss of >5% did have a prognostic value for men. The combination of male gender, preoperative weight loss, and major postoperative complications were related to early death.

CONCLUSIONS: Apart from the well-known prognostic parameters lymph node status (T classification) and status of surgical margins, preoperative weight loss and occurrence of major postoperative complications were also found to have a negative effect on the survival of male patients undergoing surgery for advanced head and neck cancer.