Impact of Severe Malnutrition on Short-term Mortality and Overall Survival in Head and Neck Cancer

Background: Basic patient and tumor characteristics impact overall survival of head and neck squamous cell carcinoma patients. Severe malnutrition, defined as weight loss > 10% in 6 months preceding primary tumor diagnosis, impacts overall survival as well. Little attention has been paid to the interaction between severe malnutrition and other relevant prognostic covariables. This study investigates the impact of malnutrition on short-term mortality and overall survival, together with the covariables age, tumor site, gender, TNM-classification, comorbidity and prior tumors.

Methods: 383 consecutive primary HNSCC patients, diagnosed and treated between 1995 and 1999 were followed until January 2010. Impact of covariables on short-term mortality and overall survival was studied univariately with Kaplan-Meier curves and the log-rank test. Cox-regression and binary logistic regression were used for multivariate analyses.

Results: 28 (7.3%) patients were severely malnourished. All covariables, except gender and prior tumors had significant impact on overall survival. The relative risk of severe malnutrition was 1.8 and is comparable to the impact of a T2 tumor, a N1 neck or moderate comorbidity. A univariate relationship between severe malnutrition and short-term mortality was established.

Conclusions: Severe malnutrition has an independent impact on overall survival of primary HNSCC patients. There is a clear distinction between patients with and without severe malnutrition from moment of diagnosis until 10 years after. This emphasizes the importance of identification and optimal treatment of malnutrition before, during and after cancer treatment.