Overweight BMI Associated With Better Head and Neck Cancer Outcomes

Patients with head and neck cancer who are being treated with chemoradiotherapymay be more likely to have improved survival outcomes if they have a body mass index (BMI) in the overweight range, according to recent research published in JAMA Network.

The research included 445 patients with head and neck cancer: 107 had a normal BMI; 179 had an overweight BMI; and 159 had an obese BMI. All patients underwent curative-intent chemoradiotherapy — which is when chemotherapy and radiotherapy are given together — at Roswell Park Comprehensive Cancer Center. Regarding the different types of head and neck cancers, 262 patients had a diagnosis of oropharynx cancer, 102 had larynx cancer and 81 had another type of cancer (not specified in the study). Seventy-six patients were HPV-negative, 225 patients were HPV-positive and 144 did not have HPV status available.

Patients were excluded from the study if they had surgery or radiotherapy as their only treatment modality, received a diagnosis of metastatic cancer, or who had an unknown or underweight BMI.

“To our knowledge, this is the largest study involving patients in the US treated with chemoradiotherapy for head and neck cancer that evaluated the role of BMI as a factor associated with survival, treatment response, and tumor recurrence outcomes,” the researchers wrote.

At an average follow-up time of 48.1 months, patients who were overweight tended to have improved overall survival (time until death of any cause) and progression-free survival (time a patient lives without their disease getting worse), as well as decreased locoregional failure at five years compared to those whose BMI was in the normal or obese range.

“Our finding of an association of overweight BMI with improved survival is consistent with a growing body of literature suggesting that a higher BMI is a favorable prognostic factor,” the researchers wrote. “However, obese BMI was not associated with (overall survival) in our study. This finding is consistent with several reports, whereas other studies have reported survival benefits associated with obese BMI.”

More specifically, at the five-year mark, 71.5% of patients with an overweight BMI were still alive, compared with 58.4% for those with a normal BMI. Five-year progression-free survival rates were 68.3% and 50.8% in the overweight and normal BMI categories, respectively.

Being overweight was associated with a lower rate of locoregional failure at the five-year mark for patients with head and neck cancer, recent research showed.

Additionally, after five years, 7% of patients with an overweight BMI experienced locoregional failure, which is when the initial site of the cancer experiences progression or recurrence, compared with 25.9% of patients with a normal BMI. Of note, the five-year locoregional failure rate for patients with an obese BMI was 10.4%, though the difference between the obese and normal BMI groups was not found to be statistically significant, meaning that the researchers could not definitively say that it was BMI that caused the difference in locoregional failure between the two groups.

“Although a few other studies have suggested that a higher BMI is associated with improved survival, they also included patients with an underweight BMI as a reference group, which was previously shown to be associated with worse survival outcomes,” the researchers wrote.

The researchers also emphasized the need for more research on this topic, especially since there was no association observed between BMI, HPV status and outcomes.

“Our cohort study suggests that overweight BMI is an independent, favorable factor associated with complete response after treatments, (overall survival), (progression-free survival) and (locoregional control),” they concluded. “Further investigations are warranted to improve our understanding on the role of BMI among patients with head and neck cancer.”

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