Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer

Trevisani, Lorenzo Fernandes Moça; Kulcsar, Isabelle Fernandes; Leite, Ana Kober Nogueira; Kulcsar, Marco Aurélio Vamondes; Lima, Graziele Aparecida Simões; Dedivitis, Rogerio Aparecido; Kowalski, Luiz Paulo; Matos, Leandro Luongo

doi:10.1016/j.bjorl.2021.11.003

Lorenzo Fernandes Moça Trevisani

data acquisition

data analysis

manuscript critical review

Universidade de São Paulo, Faculdade de Medicina, Programa de Pós-Graduacão em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil

https://orcid.org/0000-0003-3608-9759

Isabelle Fernandes Kulcsar

data acquisition

data analysis

manuscript preparation

Universidade Anhembi Morumbi, São Paulo, SP, Brazil

https://orcid.org/0000-0002-6363-6706

Ana Kober Nogueira Leite

data analysis

manuscript preparation

Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), Departamento de Cirurgia de Cabe¸ca e Pesco¸co, São Paulo, SP, Brazil

https://orcid.org/0000-0001-7814-757X

Marco Aurélio Vamondes Kulcsar

study design

manuscript preparation

Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), Departamento de Cirurgia de Cabe¸ca e Pesco¸co, São Paulo, SP, Brazil

https://orcid.org/0000-0002-4751-0476

Graziele Aparecida Simões Lima

data acquisition

manuscript critical review

Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil

https://orcid.org/0000-0002-0470-5265

Rogerio Aparecido Dedivitis

study design

manuscript critical review

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0002-6267-1147

Luiz Paulo Kowalski

study design

manuscript critical review

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil

https://orcid.org/0000-0001-5865-9308

Leandro Luongo Matos ^**Corresponding author. E-mail:l.matos@fm.usp.br (L.L. Matos).

study design

data analysis

manuscript preparation

Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil

Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0002-5068-8208

*Corresponding author. E-mail:l.matos@fm.usp.br (L.L. Matos).

Peer Review under the responsibility of Associa¸cão Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Conflicts of interest

All authors have read and approved the final manuscript and do not have actual, potential, or apparent conflict of interest with regard to the manuscript submitted for review.

Features	Results
Demographic data
Male	138 (77.5%)
Female	40 (22.5%)
Age (mean ± SD)	59.5 ± 11.5 years
Primary site
Retromolar area	31 (17.4%)
Lower alveolar ridge	22 (12.4%)
Upper alveolar ridge	11 (6.2%)
Tongue	17 (9.6%)
Buccal mucosa	13 (7.3%)
Hard palate	10 (5.6%)
Floor of the mouth	74 (41.6%)
Smokers	148 (83.1%)
Alcohol abuse	125 (70.2%)
Anatomopathological data
Free resection margins	148 (83.1%)
Degree of differentiation
Well	33 (18.8%)
Moderately	125 (71.0%)
Poor	18(10.2%)
Perineural invasion	120 (67.4%)
Angiolymphatic invasion	62 (34.8%)
Depth of invasion (mean ± SD) pN (pathological lymph-nodes status)	2.5 ± 1.4cm
pN0	63 (37.2%)
pN1	14 (8.2%)
pN2a	9 (5.3%)
pN2b	16 (9.4%)
pN2c	9 (5.3%)
pN3b	59 (34.7%)
Extracapsular spread	66 (61.7%)
Treatment/clinical outcome
Adjuvant radiation therapy	128 (72.3%)
Adjuvant chemotherapy	56 (31.8%)
Locoregional recurrence	46 (26%)
Distant metastasis	30 (16.9%)
Death	101 (56.7%)

Features	Result
Quantitative data ^a Mean ± Standard Deviation.
Hemoglobin (Hb)	12.3 ±2.2 g/dL
Hematocrit (Ht)	42.7±47.0%
Erythrocytes	4.0 ± 0.7 millions/mm³
RDW	14.0± 1.5%
Leukocytes	15.8±69.8^a Mean ± Standard Deviation. 1000/mm³
Neutrophils	8.0±5.7^a Mean ± Standard Deviation. 1000/mm³
Lymphocytes	12.6±156.3^a Mean ± Standard Deviation. 1000/mm³
Neutrophil/lymphocyte ratio	5.7±5.4
Platelets	269.3 ±102.06^a Mean ± Standard Deviation. 1000/mm³
Usual weight	67.4 ± 15.3 kg
Weight on the day before surgery	62.7± 14,6kg
Weight loss over usual weight	6.4 ±7.7%
Body Mass Index (BMI)	23.0 ±4.6 kg/m²
Minimum healthy weight	53.9 ± 6.5 kg
Ideal weight according to mean BMI	62.2 ±6.5 kg
Time of use of feeding tube (postoperative period)	5.2±4.2 months
Time of oral supplement use (postoperative period)	1.9 ±3.0 months
Number of consultations with nutritionists in the first year	7.0±4.9
Stratified data
Hb < 14.3 g/dL	143 (80.3%)
Hb < 10g/dL	30 (16.9%)
RDW > 14.3%	54 (30.3%)
Neutrophil/leukocyte ratio > 2.2	144 (80.9%)
Weight loss over usual weight > 10%	49 (28.2%)
Weight loss in relation to usual weight (yes)	140 (78.7%)
Malnourished/underweight (parameter)	39 (22.0%)
Under healthy minimum weight (parameter)	37 (20.8%)
Use of feeding tube in the postoperative period	171 (96.1%)
Use of oral supplement in the postoperative period	86 (48.3%)
Postoperative nutritional follow-up	151 (84.8%)
≥3 consultations	139 (78.1%)
≥4 consultations	129 (72.5%)
≥6 consultations	111 (62.4%)
≥10 consultations	57 (32.0%)
Diet in the first postoperative year
Exclusive oral	60 (55.6%)
Exclusive Enteral	43 (39.8%)
Mixed	5 (4.6%)

Features	HR	95% IC	p
Age	1.012	0.994–1.030	0.190
Sex	0.911	0.563–1.474	0.704
Smoking	0.921	0.546–1.553	0.758
Alcohol abuse	0.830	0.545–1.265	0.386
Positive margins	1.196	0.725–1.973	0.483
Poorly differentiated	1.464	0.779 –2.752	0.237
Perineural invasion	1.865	1.170 –2.975	0.009
Angiolymphatic invasion	1.938	1.301–2.888	0.001
Depth of invasion > 10 mm	1.808	0.984–3.320	0.056
Lymph node metastases	3.406	2.113–5.492	<0.001
Extracapsular spread	2.001	1.225–3.268	0.006
Time to adjuvant radiotherapy (>4 months)	1.136	0.629–2.052	0.673
Hemoglobin < 14.3	1.090	0.672 –1.766	0.728
Hb < 10g/dL	1.805	1.100 –2.962	0.019
RDW > 14.3%	2.042	1.355 –3.077	0.001
Neutrophil/lymphocyte ratio > 2.2	1.706	0.984 –2.956	0.057
Percentage of loss compared to usual weight > 10%	2.040	1.351–3.079	0.001
Weight loss in relation to usual weight (yes)	1.271	0.743–2.174	0.381
Malnourished/Underweight	1.096	0.682–1.759	0.706
Under healthy minimum weight (yes)	1.112	0.687–1.800	0.667
Below ideal weight according to mean BMI (yes)	1.218	0.813–1.825	0.339
Use of enteral tube	0.560	0.244–1.282	0.170
Use of oral supplement	0.919	0.621–1.361	0.675
Follow-up with nutrition team after surgery	0.812	0.475–1.388	0.448

Features	HR	95% IC	p
Perineural invasion	0.985	0.506–1.916	0.964
Angiolymphatic invasion	1.325	0.824–2.129	0.245
Depth of invasion > 10 mm	1.749	0.823–3.716	0.146
Lymph node metastases	^a HR, Hazard Ratio; 95% CI, Confidence Interval 95%; p, value of p.	^a HR, Hazard Ratio; 95% CI, Confidence Interval 95%; p, value of p.	^a HR, Hazard Ratio; 95% CI, Confidence Interval 95%; p, value of p.
Extracapsular spread	1.697	1.018–2.831	0.043
Hb < 10g/dL	0.994	0.530–1.865	0.986
RDW > 14.3%	2.210	1.378–3.551	0.001
Neutrophil/lymphocyte ratio > 2.2	0.972	0.492–1.917	0.936
Percentage of loss compared to usual weight > 10%	1.679	1.046–2.693	0.032

	Events	Cumulative survival	Median survival
Extracapsular spread
Absent	23/41	38.5%	26 months
Present	55/66	6.6%	10 months
RDW
<14.3%	62/123	31.1%	42 months
>14.3%	38/54	27.5%	11 months
Percentage of loss in relation to usual weight
<10%	60/124	37.0%	49 months
>10%	37/49	8.9%	13 months

[1] *Corresponding author. E-mail:l.matos@fm.usp.br (L.L. Matos).

Brasil

Brasil

Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer^☆ ☆ Study conducted at the Cancer Institute of São Paulo (ICESP), University of São Paulo Medical School, São Paulo, SP, Brazil.

Abstract

Objective:

Methods:

Results:

Conclusion:

Level of evidence:

HIGHLIGHTS

Brasil

Brasil

Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer☆ ☆ Study conducted at the Cancer Institute of São Paulo (ICESP), University of São Paulo Medical School, São Paulo, SP, Brazil.

Abstract

Objective:

Methods:

Results:

Conclusion:

Level of evidence:

HIGHLIGHTS

Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer^☆ ☆ Study conducted at the Cancer Institute of São Paulo (ICESP), University of São Paulo Medical School, São Paulo, SP, Brazil.