Table 2.
Baseline characteristics and treatment interval changes during the CCRT course in 123 patients with LAHNSCC undergoing CCRT stratified by tumor location and CCRT settings stratified by 30 kcal/kg/day calorie supply.
| OCC with Adjuvant CCRT | NOCC with Primary CCRT | |||||
|---|---|---|---|---|---|---|
| CCRT Completion | CCRT Completion | |||||
| Variables, Expressed as Numbers (%) or Mean ± SD |
25–30 kcal/kg/day | ≥30 kcal/kg/day | p-Value | 25–30 kcal/kg/day | ≥30 kcal/kg/day | p-Value * |
| Patient number | 48 (69.6) | 21 (30.4) | 43 (79.6) | 11 (20.4) | ||
| Clinicopathologic | ||||||
| Age (years) | 52.6 ± 8.7 | 54.5 ± 7.9 | 0.389 | 55.3 ± 8.5 | 55.2 ± 8.9 | 0.961 |
| Sex (male/female) | 47 (97.9): 1 (2.1) | 21 (100.0): 0 (0.0) | 0.505 | 41 (95.3): 2 (4.7) | 10 (90.9): 1 (9.1) | 0.566 |
| Tumor location (OCC/NOCC) | 0.353 | 0.441 | ||||
| Buccal mucosa/Tonsil | 17 (35.4) | 3 (14.2) | 10 (23.2) | 3 (27.2) | ||
| Tongue/Tongue base | 18 (37.5) | 10 (47.6) | 5 (11.6) | 1 (9.1) | ||
| Gingiva/Soft palate | 8 (16.6) | 5 (23.8) | 2 (4.7) | 1 (9.1) | ||
| Mouth floor/Hypopharynx | 2 (4.2) | 1 (4.8) | 19 (44.2) | 5 (45.5) | ||
| Retromolar/Larynx | 1 (2.1) | 1 (4.8) | 7 (16.3) | 1 (9.1) | ||
| Lip/Nasopharynx | 2 (4.2) | 0 (0.0) | -- | -- | ||
| Hard palate | 0 (0.0) | 1 (4.8) | -- | -- | ||
| TNM stage (III vs. IVA vs. IVB) | 2 (4.2): 34 (70.8): 12 (25.0) | 2 (9.5): 32 (76.2): 3 (14.3) | 0.460 | 4 (9.3): 28 (65.1): 11 (25.6) | 1 (9.1): 7 (63.6): 3 (27.3) | 0.993 |
| T status (T0-2 vs. T3-4) | 6 (12.5): 42 (87.5) | 2 (9.5): 15 (90.5) | 0.722 | 17 (39.5): 26 (60.5) | 3 (27.2): 8 (72.8) | 0.452 |
| N status (N0-1 vs. N2-3) | 22 (45.8): 26 (54.2) | 8 (38.1):13 (61.9) | 0.551 | 8 (18.6): 35 (81.4) | 3 (27.2): 8 (72.8) | 0.524 |
| ECOG performance status (0: 1: 2) | 2 (4.2): 43 (89.5): 3 (6.3) | 0 (0.0): 18 (85.7): 3 (14.3) | 0.371 | 6 (14.0): 37 (86.0): 0 (0.0) | 0 (0.0): 10 (90.9): 1 (9.1) | 0.065 |
| Histological grade (1: 2: 3) | 6 (12.5): 35 (72.9): 7 (14.6) | 2 (9.5): 16 (76.2): 3 (14.3) | 0.935 | 2 (4.4): 29 (63.0): 15 (32.6) | 1 (8.3): 6 (50.0): 5 (41.7) | 0.675 |
| Smoking (no/yes) | 5 (10.4): 43 (89.6) | 1 (4.5): 20 (90.2) | 0.443 | 4 (9.3): 39 (90.7) | 1 (9.1): 10 (90.9) | 0.983 |
| Alcohol (no/yes) | 13 (27.1): 351 (72.9) | 5 (23.8): 16 (76.2) | 0.776 | 12 (27.9): 31 (72.1) | 1 (9.1): 10 (90.9) | 0.193 |
| Betel nut (no/yes) | 11 (22.9): 37 (77.1) | 5 (23.8): 16 (76.2) | 0.936 | 20 (46.5): 23 (53.5) | 7 (68.6): 4 (31.4) | 0.311 |
| HN-CCI (0 vs. 1 vs. 2 vs. ≥3) | 19 (39.5): 13 (27.1): 2 (6.3): 13 (27.1) | 10 (47.6): 2 (9.5): 3 (14.3): 6 (28.1) | 0.478 | 16 (37.1): 12 (27.9): 6 (14.0): 9 (21.0) | 5 (45.5): 4 (36.4): 0 (0.0): 2 (18.1) | 0.715 |
| Tracheostomy (no/yes) | 19 (39.6): 29 (60.4) | 4 (19.0): 17 (81.0) | 0.096 | 22 (47.8): 24 (52.2) | 7 (68.6): 4 (31.4) | 0.088 |
|
PG-SGA (stage A vs. stage B vs. stage
C) before CCRT |
8 (16.7): 29 (60.4): 11 (22.9) | 5 (23.8): 9 (42.9): 7 (33.3) | 0.402 | 3 (8.7): 28 (63.0): 12 (28.3) | 2 (18.2): 5 (45.4): 4 (36.4) | 0.377 |
| Anthropometric and blood NIB data | ||||||
| Before CCRT | ||||||
| BW (kg) | 65.3 ± 12.5 | 54.9 ± 7.7 | <0.001 * | 65.1 ± 10.5 | 51.0 ± 11.7 | <0.001 * |
| BMI (kg/m2) | 23.9 ± 0.4 | 20.2 ± 0.7 | 0.001 * | 23.6 ± 3.5 | 19.1 ± 3.8 | 0.001 * |
| Hb (g/dL) | 11.7 ± 1.6 | 11.6 ± 1.0 | 0.780 | 11.9 ± 1.7 | 11.8 ± 1.6 | 0.820 |
| WBC (×103 cells/mm3) | 7.1 ± 2.4 | 7.6 ± 2.7 | 0.409 | 7.4 ± 3.2 | 5.9 ± 1.8 | 0.144 |
| Platelet count (×103/mm3) | 324.6 ± 126.4 | 378.9 ± 186.2 | 0.233 | 246.4 ± 71.6 | 270.0 ± 90.0 | 0.363 |
| TLC (×103 cells/mm3) | 1.0 ± 0.6 | 1.1 ± 0.7 | 0.905 | 1.9 ± 0.7 | 1.6 ± 0.4 | 0.115 |
| Albumin (g/dL) | 3.8 ± 0.5 | 3.8 ± 1.5 | 0.601 | 3.9 ± 0.4 | 3.6 ± 0.6 | 0.055 |
| CRP (mg/dL) | 10.5 ± 1.9 | 13.0 ± 4.0 | 0.521 | 18.1 ± 7.2 | 20.6 ± 12.6 | 0.879 |
| NLR | 3.4 ± 0.4 | 5.3 ± 2.5 | 0.307 | 2.9 ± 0.5 | 2.7 ± 0.4 | 0.809 |
| PLR | 216.4 ± 23.7 | 235.1 ± 31.4 | 0.678 | 137.1 ± 28.9 | 158.4 ± 23.0 | 0.643 |
| PNI | 47.1 ± 5.9 | 46.3 ± 6.8 | 0.661 | 48.9 ± 5.2 | 46.0 ± 5.7 | 0.073 |
| Treatment interval change (%) | ||||||
| ΔBW% ** | −5.3 ± 0.9 | −1.4 ± 1.1 | 0.019 * | −6.4 ± 1.2 | −0.2 ± 2.1 | 0.023 * |
| ΔBMI% ** | −4.9 ± 0.9 | −1.3 ± 1.2 | 0.040 * | −6.7 ± 1.2 | −0.4 ± 2.0 | 0.001 * |
| ΔHb% ** | −7.4 ± 2.2 | −9.7 ± 2.7 | 0.538 | −12.9 ± 2.0 | −7.2 ± 4.8 | 0.225 |
| ΔWBC% ** | −24.3 ± 4.6 | −15.5 ± 13.6 | 0.445 | −27.8 ± 6.2 | −13.0 ± 14.1 | 0.198 |
| ΔPlatelet% ** | −20.1 ± 4.4 | −21.9 ± 6.8 | 0.818 | −17.8 ± 6.1 | −29.3 ± 7.9 | 0.152 |
| ΔTLC% ** | −41.5 ± 4.9 | −33.7 ± 16.1 | 0.550 | −49.2 ± 5.5 | −63.2 ± 8.0 | 0.238 |
| ΔAlbumin% ** | 6.3 ± 2.7 | 7.6 ± 7.8 | 0.847 | 1.4 ± 2.8 | 1.9 ± 8.2 | 0.237 |
| ΔCRP% ** | 84.5 ± 10.8 | 98.0 ± 6.6 | 0.614 | 55.1 ± 22.3 | 80.5 ± 42.1 | 0.404 |
| ΔNLR% ** | 5.3 ± 2.5 | 3.4 ± 1.8 | 0.027 * | 4.8 ± 7.1 | 12.4 ± 23.6 | 0.292 |
| ΔPLR% ** | 113.9 ± 30.9 | 89.8 ± 33.1 | 0.684 | 137.1 ± 27.8 | 237.2 ± 78.8 | 0.185 |
| ΔPNI% ** | −4.8 ± 2.3 | −5.8 ± 3.3 | 0.807 | −9.9 ± 1.8 | −11.6 ± 4.5 | 0.692 |
| Body composition parameters | ||||||
| Before CCRT | ||||||
| LBM (kg) | 45.2 ± 5.1 | 40.4 ± 3.6 | <0.001 * | 44.8 ± 6.2 | 38.4 ± 7.2 | 0.004 * |
| TFM (kg) | 19.3 ± 9.1 | 11.8 ± 5.4 | 0.001 * | 17.4 ± 5.5 | 10.2 ± 4.8 | <0.001 * |
| ASM (kg) | 19.2 ± 2.9 | 16.6 ± 2.5 | 0.001 * | 19.6 ± 3.4 | 15.4 ± 3.8 | 0.001 * |
| Android (%) | 32.8 ± 12.9 | 22.3 ± 11.5 | 0.002 * | 32.7 ± 9.1 | 19.9 ± 9.6 | <0.001 * |
| Gynoid (%) | 27.4 ± 8.2 | 21.7 ± 7.2 | 0.007 * | 26.4 ± 9.7 | 19.4 ± 4.4 | <0.001 * |
| Treatment interval change (%) | ||||||
| ΔLBM% ** | −7.1 ± 5.8 | −3.9 ± 4.7 | 0.001 * | −5.7 ± 7.2 | −2.4 ± 4.0 | 0.021 * |
| ΔTFM% ** | −7.5 ± 13.9 | 8.1 ± 17.2 | <0.001 * | −8.9 ± 16.0 | 6.1 ± 6.3 | 0.015 * |
| ΔASM% ** | −8.4 ± 7.5 | −6.3 ± 8.0 | 0.280 | −8.7 ± 10.3 | −5.1 ± 7.1 | 0.276 |
| ΔAndroid% ** | −4.8 ± 19.2 | 11.9 ± 22.5 | 0.002 * | −7.8 ± 5.2 | 19.2 ± 12.8 | 0.005 * |
| ΔGynoid% ** | 2.6 ± 12.2 | 8.5 ± 18.7 | 0.126 | 1.0 ± 2.6 | 10.9 ± 8.5 | 0.109 |
| Mean daily calorie intake during CCRT | 25.2 ± 4.3 | 38.6 ± 7.0 | <0.001 * | 25.7 ± 3.8 | 36.6 ± 7.8 | <0.001 * |
| Mean protein intake during CCRT | 0.9 ± 0.9 | 1.3 ± 0.4 | 0.014 * | 0.8 ± 0.9 | 1.2 ± 0.8 | 0.021 * |
| Feeding tube placement (no/yes) | 18 (37.5): 30 (63.5) | 4 (19.0): 17 (81.0) | 0.130 | 21 (48.8): 22 (51.2) | 5 (45.5): 6 (54.5) | 0.841 |
| Mean days of feeding tube placement | 28.2 ± 4.1 | 48.8 ± 5.7 | 0.007 * | 20.6 ± 4.0 | 27.5 ± 9.5 | 0.451 |
| CCRT data | ||||||
| Radiotherapy | ||||||
| Dose (Gy) | 64.3 ± 4.5 | 64.3 ± 1.7 | 0.988 | 69.8 ± 2.9 | 69.7 ± 4.1 | 0.911 |
| Fractions | 31.8 ± 1.7 | 32.3 ± 1.6 | 0.299 | 33.3 ± 1.1 | 34.0 ± 2.3 | 0.164 |
| Duration (days) | 45.2 ± 5.4 | 47.7 ± 3.6 | 0.727 | 51.9 ± 8.5 | 50.3 ± 6.1 | 0.538 |
| Cisplatin dose (mg/m2) | 238.2 ± 23.3 | 239.1 ± 16.5 | 0.880 | 211.3 ± 10.2 | 220.9 ± 12.7 | 0.670 |
| Grade 3/4 toxicity during CCRT | ||||||
| Non-hematologic | ||||||
| Dermatitis (no/yes) | 46 (95.8): 2 (4.2) | 20 (95.2): 1 (4.8) | 0.911 | 41 (95.7): 2 (4.3) | 11 (100.0): 0 (0.0) | 0.466 |
| Pharyngitis (no/yes) | 45 (93.8): 3 (6.2) | 19 (90.5): 2 (9.5) | 0.629 | 36 (83.7): 7 (16.3) | 8 (72.8): 3 (27.2) | 0.402 |
| Infection (no/yes) | 42 (87.5): 6 (12.5) | 17 (81.0): 4 (19.0) | 0.477 | 32 (74.4): 11 (25.6) | 5 (45.5): 6 (54.5) | 0.065 |
| Mucositis (no/yes) | 35 (72.9): 13 (27.1) | 17 (81.0): 4 (19.0) | 0.476 | 32 (74.4): 11 (25.6) | 8 (72.8): 3 (27.2) | 0.909 |
| Emesis (no/yes) | 43 (89.6): 5 (10.4) | 20 (95.2): 1 (4.8) | 0.476 | 40 (93.0): 3 (7.0) | 10 (90.9): 1 (9.1) | 0.811 |
| Hematologic | ||||||
| Anemia (no/yes) | 44 (91.7): 4 (8.3) | 20 (95.2): 1 (4.8) | 0.599 | 37 (86.0): 6 (14.0) | 7 (90.9): 4 (9.1) | 0.668 |
| Neutropenia (no/yes) | 31 (64.6): 17 (35.4) | 15 (71.4): 6 (28.6) | 0.579 | 26 (60.5): 17 (39.5) | 8 (63.6): 4 (36.4) | 0.847 |
| Thrombocytopenia (no/yes) | 45 (93.8): 3 (6.2) | 20 (95.2): 1 (4.8) | 0.808 | 37 (86.0): 6 (14.0) | 10 (90.9): 1 (9.1) | 0.668 |
| 2-year mortality (%) | 18 (37.1) | 12 (57.1) | 0.045 * | 10 (23.3) | 6 (54.5) | 0.043 * |
* indicates a significant p-value < 0.05. The analytical methods used with data presented in Table S2 are identical to those used with data presented in Table 3. Abbreviations: LAHNSCC, locally advanced head and neck squamous cell carcinoma; CCRT, concurrent chemoradiotherapy; OCC, oral cavity cancer; NOCC, non-oral cavity cancer; TNM, tumor node metastasis; ECOG PS, Eastern Collaboration Oncology Group performance status; HN-CCI, head and neck Charlson Comorbidity Index; RT, radiotherapy; PG-SGA, Patient-Generated Subjective Global Assessment; BMI, body mass index; BW, body weight; Hb, hemoglobin; WBC, white blood cell count; TLC, total lymphocyte count; CRP, C-reactive protein; LBM, lean body mass; TFM, total fat mass; ASM, appendicular skeletal muscle mass; BMC, bone mineral content. Independent t-tests were used for age, BW, BMI, Hb, TLC, and albumin levels. The Mann–Whitney test was used for WBC, platelet count, CRP, and all body composition parameters. The chi-square test was used for categorical data. ** Δ indicates a value obtained by subtracting the pretreatment value from the post-treatment value. % indicates (Δ value/pretreatment value) × 100%.