Correlation between BMI and prognosis and induction chemotherapy in patients with locally advanced oral squamous cell carcinoma

doi:10.19438/j.cjoms.2023.06.005

Abstract

Abstract: PURPOSE: To evaluate the relationship between body mass index (BMI) and long-term prognosis and TPF induction chemotherapy in patients with locally advanced oral squamous cell carcinoma(OSCC). METHODS: This retrospective study included 10-year follow-up data from 253 patients with locally advanced OSCC in a previous phase Ⅲ clinical trial. Univariate and multivariate Cox regression models and Kaplan-Meier methods were used for survival analysis with SPSS 23.0 software package. RESULTS: The baseline BMI of 253 patients ranged from 13.16 to 34.66 kg/m². The BMI of patients was highly correlated with smoking status(P<0.001). There was a marked correlation with clinical nodal stage(cN), patients with higher BMIs often having an earlier cN stage(P<0.05). Kaplan-Meier analysis showed that BMI was significantly correlated with overall survival (OS, P=0.014), disease-free survival (DFS, P=0.009), locoregional recurrence-free survival (LRFS, P=0.013), and distant metastasis-free survival(DMFS, P=0.015). Multivariate Cox regression analysis found that BMI was an independent prognostic factor for OS(P=0.015), DFS(P=0.010), LRFS (P=0.015), and DMFS (P=0.016). Correlation analysis of BMI with efficacy of induction chemotherapy found that only patients with normal BMI and clinical stage Ⅳa OSCC who received TPF-induced chemotherapy had better OS(HR: 0.425, 95%CI: 0.187-0.966, P=0.041) and DMFS(HR: 0.425, 95%CI: 0.187-0.966, P=0.041). CONCLUSIONS: BMI at baseline is an independent predictor of prognosis in patients with locally advanced OSCC. Underweight patients may have a worse clinical prognosis than those who are normal weight, while those who have overweighted and obese have a better prognosis. A normal BMI in clinical stage Ⅳa OSCC patients predicts significant OS and DMFS benefits of TPF induction chemotherapy.

Key words: Body mass index, Oral squamous cell carcinoma, TPF induction chemotherapy, Prognosis

CLC Number:

R739.8

ZHAO Tong-chao, LIANG Si-yuan, ZHOU Zhi-hang, ZHU Fang-xing, JU Wu-tong, TAN Yi-ran, LIU Ying, ZHONG Lai-ping. Correlation between BMI and prognosis and induction chemotherapy in patients with locally advanced oral squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(6): 559-565.

References

[1] Caudell JJ, Gillison ML, Maghami E, et al.NCCN Guidelines^® Insights: head and neck cancers, version 1.2022[J]. J Natl Compr Canc Netw, 2022, 20(3): 224-234.
[2] Gu D, He J, Duan X, et al.Body weight and mortality among men and women in China[J]. JAMA, 2006, 295(7): 776-783.
[3] Zheng W, Mclerran DF, Rolland B, et al.Association between body-mass index and risk of death in more than 1 million Asians[J]. N Engl J Med, 2011, 364(8): 719-729.
[4] Bhaskaran K, Douglas I, Forbes H, et al.Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults[J]. Lancet, 2014, 384(9945): 755-765.
[5] Yuan C, Bao Y, Wu C, et al.Prediagnostic body mass index and pancreatic cancer survival[J]. J Clin Oncol, 2013, 31(33): 4229-4234.
[6] Balakrishnan VS.Low BMI linked to worse colorectal cancer outcomes[J]. Lancet Oncol, 2015, 16(16): e593.
[7] Protani M, Coory M, Martin JH.Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis[J]. Breast Cancer Res Treat, 2010, 123(3): 627-635.
[8] Dahlberg SE, Schiller JH, Bonomi PB, et al.Body mass index and its association with clinical outcomes for advanced non-small-cell lung cancer patients enrolled on eastern cooperative oncology group clinical trials[J]. J Thorac Oncol, 2013, 8(9): 1121-1127.
[9] Li D, Morris JS, Liu J, et al.Body mass index and risk, age of onset, and survival in patients with pancreatic cancer[J]. JAMA, 2009, 301(24): 2553-2562.
[10] Feng R, Chang ET, Liu Z, et al.Body mass index, body shape, and risk of nasopharyngeal carcinoma: a population-based case-control study in Southern China[J]. Cancer Med, 2019, 8(4): 1835-1844.
[11] Wang C, Pan Y, Xu Q, et al.Relationship between body mass index and outcomes for patients with oral squamous cell carcinoma[J]. Oral Dis, 2019, 25(1): 87-96.
[12] Iyengar NM, Kochhar A, Morris PG, et al.Impact of obesity on the survival of patients with early-stage squamous cell carcinoma of the oral tongue[J]. Cancer, 2014,120(7): 983-991.
[13] Hicks DF, Bakst R, Doucette J, et al.Impact of obesity on outcomes for patients with head and neck cancer[J]. Oral Oncol, 2018, 83: 11-17.
[14] Te Riele RJLM, Dronkers EAC, Wieringa MH, et al.Influence of anemia and BMI on prognosis of laryngeal squamous cell carcinoma: development of an updated prognostic model[J]. Oral Oncol, 2018, 78: 25-30.
[15] Zhong L, Zhang C, Ren G, et al.Randomized phase Ⅲ trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma[J]. J Clin Oncol, 2013, 31(6): 744-751.
[16] Ju WT, Liu Y, Wang LZ, et al.Phase Ⅲ trial of docetaxel cisplatin 5-fluorouracil induction chemotherapy for resectable oral cancer suggests favorable pathological response as a surrogate endpoint for good therapeutic outcome[J]. Cancer Commun (Lond), 2021, 41(3): 279-283.
[17] WHO Expert Consultation.Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies[J]. Lancet, 2004, 363(9403): 157-163.
[18] Iyengar NM, Ghossein RA, Morris LG, et al.White adipose tissue inflammation and cancer-specific survival in patients with squamous cell carcinoma of the oral tongue[J]. Cancer, 2016, 122(24): 3794-3802.
[19] Picon-Ruiz M, Morata-Tarifa C, Valle-Goffin JJ, et al.Obesity and adverse breast cancer risk and outcome: mechanistic insights and strategies for intervention[J]. CA Cancer J Clin, 2017, 67(5): 378-397.
[20] Hollander D, Kampman E, van Herpen CM. Pretreatment body mass index and head and neck cancer outcome: a review of the literature[J]. Crit Rev Oncol Hematol, 2015, 96(2): 328-338.
[21] No authors listed. Obesity: preventing and managing the global epidemic. report of a WHO consultation[J]. World Health Organ Tech Rep Ser, 2000, 894: 1-253.
[22] Gonzalez MC, Pastore CA, Orlandi SP, et al.Obesity paradox in cancer: new insights provided by body composition[J]. Am J Clin Nutr, 2014, 99(5): 999-1005.
[23] Van Cutsem E, Arends J.The causes and consequences of cancer-associated malnutrition[J]. Eur J Oncol Nurs, 2005, 9(Suppl 2): S51-S63.
[24] Morikawa T, Kuchiba A, Yamauchi M, et al.Association of CTNNB1 (beta-catenin) alterations, body mass index, and physical activity with survival in patients with colorectal cancer[J]. JAMA, 2011, 305(16): 1685-1694.
[25] Gama RR, Song Y, Zhang Q, et al.Body mass index and prognosis in patients with head and neck cancer[J]. Head Neck, 2017, 39(6): 1226-1233.
[26] Cascetta P, Cavaliere A, Piro G, et al.Pancreatic cancer and obesity: molecular mechanisms of cell transformation and chemoresistance[J]. Int J Mol Sci, 2018, 19(11): 3331-3349.
[27] Lavie CJ, De Schutter A, Patel DA, et al.Body composition and fitness in the obesity paradox-body mass index alone does not tell the whole story[J]. Prev Med, 2013, 57(1): 1-2.