Background: To evaluate and compare the prognostic performance of four nutritional indicators body mass index (BMI), serum albumin (ALB), prognostic nutritional index (PNI) and nutritional risk index (NRI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status. Methods: This prospective study which involved 1395 oral cancer patients was conducted in Fujian, China from September 2007 to November 2018. The BMI, PNI and NRI were calculated according to the following formulas: BMI = weight / height 2 (kg/m 2), PNI = albumin (g/l) + 0.005 × lymphocyte (count/μl) and NRI = (1.519 × albumin, g/ l) + (41.7× present/ideal body weight), respectively. The univariate and multivariate Cox proportional hazards models were used to compare the prognostic value of BMI, ALB, PNI and NRI in overall survival (OS) in oral cancer. Results: Patients with BMI < 18.5 kg/m 2 (VS 18.5 kg/m 2 ≤ BMI < 24 kg/m 2) had a poor survival outcome (HR = 1.585; 95% CI: 1.207-2.082). ALB, PNI, NRI were inversely correlated with OS of oral cancer (HR = 0.716; 95% CI: 0.575-0.891; HR = 0.793; 95% CI: 0.633-0.992; HR = 0.588; 95% CI: 0.469-0.738, respectively). In addition, the prognostic predictive performance of NRI was superior to BMI or ALB or PNI. Interestingly, compared with patients with better nutritional status, chemotherapy was significantly associated with poorer OS in malnourished oral cancer patients. Conclusions: BMI, ALB, PNI and NRI are of prognostic value in patients with oral cancer and the prognostic performance of NRI was superior to BMI or ALB or PNI. Malnutrition (BMI < 18.5 kg/m 2 or ALB< 40 g/l or PNI < 49.3 or NRI < 97.5) could predict an unfavorable response to chemotherapy in oral cancer patients.
This preliminary study suggests that both serum excess and deficient levels of Cu or Zn were significant correlation with oral cancer risk, which may provide a new insight on the roles of serum Cu and Zn in oral cancer.
Background To develop and validate practical prognostic indexes (PIs) for predicting the prognosis and response to postoperative adjuvant therapy in patients with oral squamous cell carcinoma (OSCC). Methods A large cohort of 1071 OSCC patients were randomized to either training set (N = 708) or validation set (N = 363). Three types of PIs were developed according to the nomogram scores, β coefficients and excess hazard ratios, respectively. Restricted cubic spline was used to demonstrate the relationship between PIs and the risks of death. Results First, a nomogram was developed incorporating age at diagnosis, smoking status, clinical stage, tumor differentiation, lymph node status, comorbidity, and neutrophil to lymphocyte ratio levels. Then, three PIs were established with high survival predictive ability, and were superior to AJCC staging system (all P < .05). The risks of death were escalated continuously with the increasing number of PIs. Interestingly, adjuvant chemoradiotherapy was positively associated with poor overall survival in patients with low PIs, but exerted a beneficial effect on patients with high PIs. Conclusion Combined nomogram with further established PIs not only predicts the survival probability of OSCC patients, but also continuously quantifies the risk of death. High PIs could predict a beneficial response to adjuvant chemoradiotherapy, whereas low PIs indicate an unfavorable response.
BackgroundTo explore the effect of smoking and drinking on survival of patients with oral cancer by comparing the characteristics and survival of nonsmoking and nondrinking (NSND) patients in contrast to smoking and/or drinking (SD) patients.MethodsThis prospective study including 1165 patients with oral cancer was conducted in Fujian, China from January 2005 to January 2019. The patients were categorized to two groups, the NSND group and SD group. We compared overall survival and disease‐specific survival between the two groups using the Kaplan‐Meier method and Cox proportional hazards regression before and after propensity score matching (PSM) to explore the effect of smoking and drinking on the prognosis of patients with oral cancer.ResultsNSND patients accounted for 55.45% (646 patients) of all the patients with oral cancer. SD patients with oral cancer tended to be older and mainly are male (98.46%) and with more advanced disease status. There are trends toward both higher risk of all‐cause death (HR = 1.678; 95% CI: 1.086‐2.594) and oral cancer specific death (HR = 1.632; 95% CI: 1.044‐2.552) in SD patients with oral cancer before PSM. After PSM, the association is still significant, with adjusted HR of 1.897 (95% CI: 1.138‐3.165) for all‐cause death and adjusted HR of 1.764 (95% CI: 1.043‐2.983) for oral cancer‐specific death. Additionally, PSM can improve the HR value and result in a stronger association.ConclusionsSocial and clinical characteristics of NSND patients differed from SD patients with oral cancer. SD patients with oral cancer have higher all‐cause mortality and oral cancer‐specific mortality than NSND patients.
Background: Although previous studies have explored the associations of modifiable lifestyle factors with oral cancer risk, few studies integrated these factors and established predictive tools for oral cancer risk in different sexes.Methods: Using a case-control study design, a total of 978 oral cancer cases and 2646 healthy controls were recruited in this study. Nomograms were constructed according to significant factors in multivariable logistic regression. Risk scores were calculated based on the nomograms and quantified the risk of oral cancer using restricted cubic spline.Results: Multivariate analyses demonstrated that smoking, alcohol drinking, tea, intake of fish, seafood, vegetables, fruits, teeth loss, regular dental visits and repetitive dental ulcer were independent factors for male oral cancer. Passive smoking, age at first intercourse, cooking oil fumes exposure, tea, intake of beans, vegetables, fruits, teeth loss, regular dental visits and repetitive dental ulcer were associated with female oral cancer. Then, two nomograms were developed for predicting the probability of oral cancer in men and women with the C-index of 0.768 (95% CI: 0.723-0.813) and 0.700 (95% CI: 0.635-0.765), respectively. Restricted cubic splines graphically revealed the risk of oral cancer in individuals with different risk scores. Moreover, the risk escalated continuously with the increasing number of the risk scores among both sexes.Conclusions: Combining nomograms with risk scores developed in this study could precisely predict oral cancer occurrence and provide an accurate risk assessment.
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