Influence of fat-free mass index on the survival of patients with head and neck cancer

Abstract

Purpose To determine whether muscle mass, defined by fat-free mass index (FFMI) measured with bioelectrical impedance analysis (BIA), is predictive of survival of head and neck squamous cell carcinoma (HNSCC) patients. Methods HNSCC patients treated between 2014 and 2018 at the Department for Nutrition of the Institute of Oncology Ljubljana were reviewed. The FFMI values from the pretreatment BIA measurements and pretreatment body mass index (BMI) were used to categorize patients into groups with low and normal muscle mass and BMI using the Global Leadership Initiative on malnutrition (GLIM) recommended cutoff values. The impact of FFMI on disease-free survival (DFS) and overall survival (OS) was determined. Results Of the 71 included patients, 31 (43.7%) had normal FFMI, and 40 (56.3%) had low FFMI, whereas 44 (62%) and 27 (38%) of the patients had normal and low BMI, respectively. Between FFMI and BMI values, a significant correlation was found (RP = 0.75, p < 0.001). Univariate regression analysis showed that FFMI (as a continuous variable) was of prognostic significance for OS (p = 0.039), which was confirmed by multivariate regression analysis (p = 0.029). The model where BMI replaced FFMI negated the prognostic value of BMI (as a continuous variable). Neither FFMI nor BMI was found to be a predictor of DFS on univariate or multivariate analysis. Conclusions In the present group of HNSCC patients, low FFMI adversely influenced OS, emphasizing the importance of using body composition measurement over BMI alone for pretreatment nutritional evaluation of these patients.

Pretreatment fat‐free mass index correlates with early death in patients with head and neck squamous cell carcinoma

“…35 Other studies have also shown that low FFMI is a risk factor for mortality and postoperative complications, both in unselected cohorts of hospitalized patients and in cancer patients. [36][37][38][39] Yilmaz et al, however, did not find any association between FFMI and mortality in patients with hematological malignancies. 40 This study further demonstrated that weight loss, calculated from patient-reported weight at 6 months prior to diagnosis to start of treatment, was associated with treatment response failure but not with survival.…”

“…Similarly, a recent retrospective study identified low pretreatment FFMI as a prognostic factor in patients with normal or high BMI who were treated for lung cancer, breast cancer or upper gastrointestinal cancer, using BIA for body mass composition measurements 35 . Other studies have also shown that low FFMI is a risk factor for mortality and postoperative complications, both in unselected cohorts of hospitalized patients and in cancer patients 36–39 . Yilmaz et al, however, did not find any association between FFMI and mortality in patients with hematological malignancies 40 …”

Malnutrition, Cancer Stage and Gastrostomy Timing as Markers of Poor Outcomes in Gastrostomy-Fed Head and Neck Cancer Patients

“…On the other hand, this result demonstrates the importance of preserving lean tissue in the early cancer stages, to maintain a better nutritional status and outcome. In fact, lean tissue is also associated with better treatment response and, consequently, a better prognosis [ 44 , 45 , 46 ]. Moreover, this study suggests that the PEG duration time positively impacts survival time in HNC patients.…”