Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Head and neck cancer (HNC) significantly impacts global cancer burden, often impairing functions like swallowing and breathing. Although advancements in treatments have improved survival, many HNC patients still experience long-term toxicities that compromise quality of life. Malnutrition is prevalent in this patient population and is linked to heightened postoperative complications and poorer outcomes. The Geriatric Nutritional Risk Index (GNRI), which assesses nutritional status through serum albumin and body weight, has shown promise for predicting surgical outcomes in cancer patients, but its role in forecasting survivorship in HNC remains underexplored.
Objective: This study evaluates the impact of preoperative nutritional status, measured by GNRI, on postoperative outcomes and treatment tolerance in HNC patients, aiming to establish GNRI as a tool for predicting survivorship, especially concerning treatment-related toxicity and tolerance.
Methods: An ambispective cohort of 510 operable HNC patients treated between January 2015 and July 2024 at two university hospitals was analyzed. GNRI scores were calculated preoperatively to classify patients into low, moderate, and high-risk nutritional groups. Primary endpoints included 90-day mortality, infection rates, major adverse events (MAEs), and ICU admissions, alongside treatment tolerance measures. Statistical analysis involved chi-square tests, logistic regression, and Cox proportional hazards models to assess associations between GNRI categories and survivorship outcomes, adjusting for age, sex, tumor stage, and Charlson Comorbidity Index (CCI).
Results: Patients in the moderate GNRI risk group demonstrated significantly higher 90-day mortality (HR = 2.34, p = 0.013), with over twice the risk compared to those in the low GNRI category. GNRI risk levels were also associated with infection rates (p = 0.049) and postoperative complications, with moderate and high-risk groups showing increased infection rates relative to low-risk patients. Logistic regression highlighted GNRI’s predictive value, revealing significant differences in infection and mortality rates (p < 0.05) across GNRI categories. ICU admissions were not significantly linked to GNRI risk (p > 0.05), although higher CCI scores independently predicted ICU stays and MAEs within 30 days post-surgery (HR = 1.18, p = 0.023). For treatment tolerance, Cox modeling indicated that patients in the high GNRI risk group experienced nearly double the intolerance events compared to lower-risk groups (HR = 2.06, p = 0.018). Time-dependent ROC analysis identified the 90-day mark as optimal for predictive accuracy, with an AUC of 0.73.
Conclusion: Preoperative GNRI is a strong predictor of survivorship in HNC, particularly for infection risk and 90-day mortality. Moderate to high GNRI risks are linked to increased post-treatment complications and intolerance, emphasizing the detrimental impact of malnutrition on HNC outcomes. These findings advocate for integrating GNRI in preoperative assessments to guide targeted nutritional interventions, potentially improving survivorship and reducing postoperative toxicity. Further investigation into GNRI’s predictive utility could refine preoperative risk stratification, advancing personalized survivorship care in head and neck oncology.