Abstract 696P
Background
Concurrent chemoradiotherapy (CCRT) is a standard treatment for locally advanced head and neck cancer (LAHNC) in the definitive setting. The Geriatric Nutritional Risk Index (GNRI) is a screening tool to predict the risk of morbidity and mortality in the elderly. Nutritional management is key during CCRT but the association between prognosis and initial nutritional status in elderly patients with LAHNC undergoing CCRT remains unknown.
Methods
Patients ≥ 65 years old with LAHNC who received definitive CCRT with cisplatin (80 mg/m2 or 100 mg/m2, every 3 weeks for three times) between 2012 and 2018 were included. Patients who did not complete radiotherapy were excluded. Patients were stratified into two groups based on the GNRI (≦98 or >98). Overall survival (OS) and event-free survival (EFS) were analyzed by the Kaplan-Meier method. Each survival was compared in two groups by using the log-rank test. The Cox proportional hazards model was adopted to find prognostic factors. GNRI, sex, T stage, and N stage were prespecified as a variable for multivariable analysis.
Results
The median age of 111 patients (88 men, 79 %) was 69 years (interquartile range: 67 - 71), among which 23 patients (20 men, 87 %) were with lower GNRI and 88 patients (68 men, 77 %) with higher GNRI. Age, sex, clinical stage, p16 status, performance status, and smoking history were not statistically different between each group. Analysis of the Kaplan-Meier curve showed the OS in the group with lower GNRI was significantly worse than that with higher GNRI (p = 0.048). In contrast, no statistical difference in the EFS was observed between the two groups (p = 0.12). Multivariable analysis revealed that lower GNRI (Hazard ratio [HR]: 3.17, 95% confidence interval [95% CI]: 1.12 - 8.96, p= 0.029) and higher N stage (HR: 4.37, 95% CI: 1.58 - 12.06, p = 0.004) were associated with worse OS. For EFS, a higher N stage was associated with a worse outcome significantly (HR: 2.54, 95% CI: 1.16 - 5.59, p = 0.02).
Conclusions
Poorer nutritional status before initiation of CCRT was associated with worse OS in elderly patients with LAHNC in the definitive setting. GNRI is a convenient tool to predict OS in elderly patients with LAHNC treated with CCRT.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
Y. Sato: Financial Interests, Personal, Sponsor/Funding: Ono Pharmaceutical Co., Ltd., Bristol Myers Squibb Company, MSD K.K., Taiho Pharmaceutical Co., Ltd. N. Fukuda: Financial Interests, Personal, Sponsor/Funding: Eisai. J. Tomomatsu: Financial Interests, Personal, Sponsor/Funding: Eisai. S. Takahashi: Financial Interests, Personal, Invited Speaker: MSD, Eisai, Daiichi Sankyo, Chugai, Ono, Taiho, BMS, Eli Lilly; Financial Interests, Personal, Advisory Board: Bayer; Financial Interests, Institutional, Invited Speaker: Taiho, Daiichi Sankyo, Novartis, Ono Pharmaceutical, Eisai, Iqvia, Bristrol Myers Squibb, Bayer, AstraZeneca. All other authors have declared no conflicts of interest.