Índice de massa corporal, resposta ao tratamento e sobrevida no câncer de cabeça e pescoço: fatores relacionados aos desfechos clínicos

Abstract

The incidence and mortality rates of cancer have been increasing globally, with head and neck cancer (HNC) accounting for 5% of cases and approximately 500.000 deaths annually. HNC can cause malnutrition due to difficulties in food intake, treatment side effects, and increased nutritional requirements. Poor nutrition impairs treatment effectiveness, increases the risk of complications, and affects patient survival. The aim of this study was to evaluate factors associated with negative outcomes of initial antitumor therapy and the relationship between pre-treatment nutritional status and survival. A retrospective cohort study was conducted with patients aged over 18 years diagnosed with HNC, treated at an oncology service in Minas Gerais, Brazil, between 2009 and 2014. Sociodemographic, clinical, and disease characteristics were extracted from electronic medical records and analyzed using multinomial logistic regression and Kaplan-Meier curves with Cox regression in SPSS Statistics and Jamovi software, respectively, with a significance level of 5%. The study included 635 patients with HNC, with a median age of 61 years (range 33–101 years). Of these, 31.7% (201) received multimodal treatment combining radiotherapy and chemotherapy. At the end of initial antitumor therapy, 45.4% (288) of patients showed disease progression, and 61.0% (126) developed locoregional recurrence. Logistic regression analysis indicated that delays in treatment initiation (p < 0.004), continued smoking (p < 0.001), tumor staging (p < 0.033), and lymph node involvement (p < 0.001; p < 0.032) were associated with worse outcomes. Weight and height data were available for only 201 patients. Of these, 48% (96) were underweight, 42% (85) had normal weight, and 10% (20) were overweight. In univariate analysis, overweight patients had significantly better overall survival (OS) (HR = 0.60; 95% CI = 0.31-1.14; p = 0.035) and disease-specific survival (DSS) (HR = 0.45; 95% CI = 0.20- 0.99; p = 0.047). However, statistical significance was not maintained in multivariate analysis. The overweight group had a higher median (MD) survival time (OS = MD 32 months; 95% CI = 6-103; and DSS = MD 37 months; 95% CI = 23-62), compared to the underweight group (OS = MD 8 months; 95% CI = 6-13; and DSS = MD 13 months; 95% CI = 8-18) and normal weight group (OS = MD 12 months; 95% CI = 8-20; and DSS = MD 15 months; 95% CI = 11-23). However, it is important to consider the risks associated with obesity when evaluating these outcomes. In conclusion, the analysis revealed that factors such as delayed treatment initiation, continued smoking, and advanced tumor staging are associated with disease progression and mortality. Furthermore, pre-treatment nutritional status impacts survival, with other factors also influencing outcomes. These findings emphasize the importance of early diagnosis and treatment, the implementation of targeted nutritional interventions, and continuous monitoring of at-risk groups, with personalized therapeutic approaches for each patient.