Clinical Impact of Cachexia in Head and Neck Cancer Patients Who Received Chemoradiotherapy

Figures & data

Table 1 Patients’ Characteristics

		Definitive CCRT							Adjuvant CCRT
		Cachexia n=26			Without Cachexia n=122			P value	Cachexia n=14			Without Cachexia n=30		P value
		n		(%)	n		(%)		n		(%)	n	(%)
Age	Median (range)	58.5 (37–73)			61.0 (36–78)			0.29	61.0 (43–72)			60.0 (20–76)		0.63
Sex	Male	21	(80.8)		98	(80.3)		1.00	11	(78.6)		29	(96.7)	0.08
	Female	5	(19.2)		24	(19.7)			3	(21.4)		1	(3.3)
PS	0	18	(69.2)		112	(91.8)		<0.01	10	(71.4)		24	(80.0)	0.70
	≥1	8	(30.8)		10	(8.2)			4	(28.6)		6	(20.0)
Smoking	Yes	21	(80.8)		98	(80.3)		1.00	10	(71.4)		24	(80.0)	0.70
	No	5	(19.2)		24	(19.7)			4	(28.6)		6	(20.0)
Primary site	Naso/oropharynx	10	(38.5)		62	(50.8)		0.28	2	(14.3)		4	(13.3)	1.00
	Other	16	(61.5)		60	(49.2)			12	(85.7)		26	(86.7)
P16	Positive	6	(23.1)		44	(36.1)		0.45	1	(7.1)		5	(16.7)	0.63
	Negative	14	(53.8)		61	(50.0)			9	(64.3)		15	(50.0)
	Unknown	6	(23.1)		17	(13.0)			4	(28.6)		6	(20.0)
Stage	I–III	12	(46.2)		89	(73.0)		0.01	4	(28.6)		10	(33.3)	1.00
	IV	14	(53.8)		33	(27.0)			10	(71.4)		20	(66.6)
Sarcopenia	Yes	12	(46.2)		33	(27.0)		<0.01	2	(14.3)		6	(20.0)	0.56
	No	7	(26.9)		87	(71.3)			3	(21.4)		24	(80.0)
	Unknown	7	(26.9)		2	(1.6)			9	(64.3)		0	(0.0)
Baseline albumin	Median (range)	4.1(2.5–4.3)			4.2 (3.3–4.9)			<0.01	4.0 (3.5–4.6)			4.1 (2.1–4.5)		0.89
CCRT dose	Median	240			300			0.22	240			260		0.42
RT dose	Median (range)	66 (60–66)			66 (60–70)			0.52	66 (60–70)			66 (46–70)		0.16

Abbreviations: PS, performance status; CCRT, concurrent chemoradiotherapy; RT, radiation therapy.

Figure 1 CONSORT diagram of this study.

Figure 2 Kaplan–Meier curves for progression-free survival and overall survival according to treatment setting. Definitive CCRT-progression-free survival (PFS) (A), definitive CCRT-overall survival (OS) (B), adjuvant CCRT-progression-PFS (C) and adjuvant CCRT-OS (D) comparing patients with cachexia vs those without cachexia.

Table 2 Univariate and Multivariate Analysis for PFS

	Definitive CCRT						Adjuvant CCRT
	Univariate			Multivariate			Univariate
	HR	95% CI	P value	HR	95% CI	P value	HR	95% CI	P value
Age, ≥65	0.95	0.50–1.80	0.88	1.01	0.52–1.95	0.96	0.46	0.18–1.18	0.10
Sex, Male	1.36	0.60–3.07	0.44	1.54	0.67–3.51	0.30	1.08	0.25–4.60	0.91
PS, ≥1	1.94	0.89–4.19	0.09				1.66	0.68–4.07	0.26
Smoking, Current/former	0.91	0.44–1.91	0.83				0.66	0.26–1.68	0.38
Primarysite, Naso/oropharynx	0.55	0.29–1.03	0.06				0.96	0.28–3.24	0.95
Stage, IV	3.40	1.86–6.22	<0.01	2.74	1.46–5.12	<0.01	2.83	0.96–8.35	0.05
Baseline albumin, <4	2.97	1.62–5.44	<0.01	2.83	1.53–5.23	<0.01	0.70	0.30–1.60	0.40
Cachexia	4.01	2.15–7.47	<0.01	3.51	1.65–6.01	<0.01	0.48	0.18–1.31	0.15

Abbreviations: PS, performance status; CCRT, concurrent chemoradiotherapy.

Table 3 Univariate and Multivariate Analyses for OS

	Definitive CCRT						Adjuvant CCRT
	Univariate			Multivariate			Univariate
	HR	95% CI	P value	HR	95% CI	P value	HR	95% CI	P value
Age, ≥65	0.85	0.37–1.94	0.69	0.89	0.38–2.11	0.80	0.26	0.07–0.95	0.04
Sex, Male	1.56	0.54–4.52	0.41	2.10	0.68–6.41	0.19	1.45	0.19–11.0	0.71
PS, ≥1	2.56	1.04–6.40	0.04	1.23	0.47–3.20	0.66	0.68	0.19–2.39	0.54
Smoking, Current/former	0.67	0.28–1.60	0.37				1.03	0.29–3.62	0.96
Primarysite, Naso/oropharynx	0.58	0.26–01.28	0.18				0.82	0.18–3.01	0.79
Stage, IV	3.99	1.83–8.73	<0.01	2.64	1.15–6.07	0.02	3.77	0.85–16.6	0.07
Baseline albumin, <4	4.01	1.88–8.56	<0.01	3.91	1.78–8.59	<0.01	0.62	0.22–1.72	0.36
Cachexia	5.81	2.72–12.41	<0.01	4.31	1.93–9.61	<0.01	0.64	0.20–2.01	0.45

Abbreviations: PS, performance status; CCRT, concurrent chemoradiotherapy.

Table 4 Frequency of Adverse Events of More Than Grade 3

	Definitive CCRT							Adjuvant CCRT
	Cachexia n=26			Without Cachexia n=122			P value	Cachexia n=14		Without Cachexia n=30		P value
	n	(%)		n	(%)			n	(%)	n	(%)
Anemia	6	(23.1)		1	(0.8)		<0.01	0	(0.0)	4	(13.3)	0.20
Leukopenia	14	(53.8)		40	(32.7)		<0.01	8	(57.1)	14	(46.7)	0.89
Neutropenia	6	(23.1)		24	(19.7)		0.03	6	(42.9)	13	(43.3)	0.95
Thrombocytopenia	2	(7.7)		1	(0.8)		0.09	0	(0.0)	1	(3.3)	0.17
Liver failure	0	(0.0)		1	(0.8)		0.38	1	(7.1)	0	(0.0)	0.17
Renal failure	0	(0.0)		0	(0.0)		1.00	0	(0.0)	0	(0.0)	1.00

Abbreviation: CCRT, concurrent chemoradiotherapy.