Is there a survival advantage of oral immunonutrition in head and neck cancer?

Immunomodulatory enteral nutrition in post-surgical gastrointestinal cancer: Clinical, biochemical and nutritional impacts

BACKGROUND

Evidence shows that most gastrointestinal cancer patients develop malnutrition, which may contribute to immune function depression; inflammatory response disturbance, and stress response exacerbation, making these patients often present bad surgical results such as infections, delayed surgical wound healing, and longer hospital stays. One of the proposed nutritional strategies to combat this situation is immunonutrition, which provides nutrients that modulate the immune system activity and has been associated with better results in critically ill and surgical oncologic patients. However, the results regarding its efficiency are controversial. Thus, this article aims to evaluate the clinical, biochemical, and nutritional effects of enteral immunonutrition in patients submitted to gastrointestinal cancer surgery.

METHODS

A randomized nutritional intervention study was developed in a reference hospital for oncological treatment. Gastrointestinal cancer patients undergoing surgical treatment were randomized into two groups: one receiving standard enteral nutrition and the other receiving immunomodulatory enteral nutrition. Baseline, clinical, and nutritional data were collected. Nutritional support was started immediately after surgery when clinically recommended, and its effects on clinical, biochemical, and nutritional markers were assessed.

RESULTS

100 patients were divided into two groups, 50 in each group. It was observed lower frequency in cases of diarrhea and post-surgical complications such as fistula and sepsis, lower gastric residue, and best parameters related to the nutritional status of iron and vitamin B12, a better immune pattern such as a higher number of lymphocytes and less than leukocytes, lower values of inflammatory acute phase proteins and significantly higher Albumin/Globulin ratio in the group receiving immunomodulatory enteral nutrition, suggesting an improvement in the profile of inflammatory markers.

CONCLUSIONS

Results suggest that immunomodulatory nutritional support for patients with gastrointestinal tract cancer submitted to surgery may promote a reduction in severe postoperative complications, such as fistula with sepsis and evisceration, and improve markers of immune function and renal efficiency.

The prognostic-nutritional index in HPV-negative head and neck squamous cell carcinoma treated with upfront surgery: a multi-institutional series

Objectives

To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC).

Methods

A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models.

Results

The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 10³/microL), and undetectable basophile count (= 0 10³/microL) were independently associated with better OS and RFS.

Conclusions

PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived.

Poor treatment tolerance in head and neck cancer patients with low muscle mass

BACKGROUND

We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC).

METHODS

A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome.

RESULTS

One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders.

CONCLUSION

Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Association Between Vitamin D Exposure and Head and Neck Cancer: A Systematic Review With Meta-Analysis

BACKGROUND

Vitamin D deficiency is a well-described preventable cause of many cancers; the association of vitamin D use with the development of head and neck cancer (HNC) is not clear. We aim to conduct a systematic review of the studies assessing the relation between vitamin D exposure and the prevention and prognosis of the HNC using meta-analysis.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science up to 1 January 2021, and reference lists of related studies were searched. We extracted observational studies reporting the association between vitamin D (vitamin D receptor gene polymorphisms, 25-hydroxyvitamin D concentrations, and vitamin D intake) and the outcomes of interest (HNC incidence and HNC mortality) in HNC patients aged 18 or older. Fixed effects models were used to calculate pooled effect sizes and 95% confidence intervals (CIs) by RevMan (version 5.3).

RESULTS

Sixteen studies with a total of 81,908 participants were enrolled in our meta-analysis. Based on the pooled genomic analysis, comparing with participants with the genotypes of Ff + FF or FF, the pooled odds ratio (OR) of participants with the genotype of ff was 0.77 (95% CI: 0.61 to 0.97) and 0.75 (0.58 to 0.97), respectively. A similar trend was noted when comparing tt with Tt + TT or TT, in which OR (95% CI) was 0.70 (0.55 to 0.90) and 0.72 (0.55 to 0.95). No significant association was identified between BsmI polymorphism and HNC. Furthermore, the OR of HNC incidence was 0.77 (0.65 to 0.92) for participants with vitamin D intake over the ones with a regular diet. High concentrations of circulated 25-hydroxyvitamin D (25-OHD) significantly decreased by 32% of HNC incidence (OR (95% CI): 0.68 (0.59 to 0.78)) and increased HNC survival (pooled hazard ratio 1.13, 1.05 to 1.22) during a 4-5 years follow-up. High concentrations of circulating 25-OHD in patients with HNC led to a decreased risk of mortality to 0.75 (0.60 to 0.94) as the follow-up extends to 8-12 years.

CONCLUSIONS

Elevated activities of vitamin D by diet intake, genomic polymorphisms, or circulated 25-OHD may protect people from HNC and improve the prognosis of patients with HNC.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42020176002 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=176002).