Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_39_2577 - Impact of Obesity on Outcomes for Patients with Head/Neck Cancer

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Impact of Obesity on Outcomes for Patients with Head/Neck Cancer
D. F. Hicks1, R. L. Bakst2, J. Doucette1, B. H. Kann3, B. Miles1, E. Genden1, K. Misiukiewicz1, M. Posner1, and V. Gupta1; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Icahn School of Medicine at Mount Sinai Department of Radiation Oncology, New York, NY, 3Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT

Purpose/Objective(s): While the effect of obesity on prognosis in many cancers has been well documented, its prognostic role in head and neck squamous cell carcinoma (HNSCC) is less defined. Evidence suggests that high body mass index (BMI) may be associated with improved prognosis, but its effect on disease-specific outcomes has not been well described. This study aims to determine the effect of high BMI prior to treatment on recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in addition to overall survival (OS).

Materials/Methods: For patients with newly diagnosed HNSCC undergoing radiation therapy (RT) at a single institution, BMI at diagnosis was calculated and categorized as normal (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2) and obese (≥30 kg/m2). Underweight patients were not included. OS, RFS, LRRFS, and DMFS were compared by BMI group using Cox regression.

Results: 341 patients of median age 59 (range, 20-93) who underwent RT with curative intent from 2010-2017 and had height/weight data recorded prior to initiating treatment were included. 60% were former or current smokers and 23% were former or current alcoholics (> 2 drinks/day). 28% were obese, 40% were overweight and 33% had normal BMI prior to treatment. 58% had cancer of the oropharynx, 5% nasopharynx, 15% oral cavity, 17% larynx and 4% hypopharynx. 7% had stage I, 8% stage II, 13% stage III, 67% stage IVA, and 5% stage IVB. 59% had definitive RT and 41% had postoperative RT. 68% had concurrent chemotherapy, 42% of which also had induction chemotherapy. Current alcoholic and smoking status, advanced tumor stage, tumors of the hypopharynx/larynx, and placement of a percutaneous endoscopic gastrostomy (PEG) tube were significantly more common in patients with lower BMI. Median follow-up was 30 months (range, 3-91). Higher BMI was independently associated with improved OS (Overweight: HR = .49; 95% CI, .25 to .95; Obese: HR = .27; 95% CI, .11 to .65; P < .01), RFS (Overweight: HR = .69; 95% CI, .40 to 1.18; Obese: HR = .44; 95% CI, .22 to .87; P = .05), and DMFS (Overweight: HR = .51; 95% CI, .25 to 1.07; Obese: HR = .36; 95% CI, .14 to .95; P = .05) compared with normal BMI after adjusting for patient and treatment factors. The association was not significant for LRRFS (Overweight: HR = .79; 95% CI, .42 to 1.51; Obese: HR = .49; 95% CI, .22 to 1.10; P = .22). Similar results were found when adjusting for pathologic factors in a subset of patients who underwent surgery and adjuvant RT.

Conclusion: Being overweight or obese at the time of HNSCC diagnosis is an independent prognostic factor conferring a better prognosis, primarily by improving distant control. Further work needs to be done to determine why increased body mass may lead to fewer distant metastases.

Author Disclosure: D.F. Hicks: None. J. Doucette: None. B.H. Kann: None. B. Miles: None. K. Misiukiewicz: None. M. Posner: DMC for studies; Merck. DMC for a clinical trial; Cel Sci. Stock; promedior.

Daniel Hicks, BA


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