Nutritional Gender-Specific Differences in Head and Neck Cancer Patients Treated with (Chemo)Radiotherapy: Results from a Prospective Trial
by
, , ,
Rouzbeh Zohri
1,2,3,†,
Lorenz Hahn
4,†,
Niloufar Seyedi
5,6,
Cordula Petersen
7,8,
Christian Ziemann
9,
Jakob Abel
7,10,
Laura Magdalena Kutz
7,
Andreas Krüll
7,8,
Charlotte Flüh
11,
Carolin Ehresmann
9,
Oksana Zemskova
12,
Larysa Liubich
12,13,
Dirk Rades
9 and 
Anastassia Löser
9,* 1
Department of Osteology, Outpatient Center, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
2
Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Clinic Hamburg, 21033 Hamburg, Germany
3
Department of Trauma Surgery and Orthopaedics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
4
Tetra Pak Processing GmbH, 21509 Reinbek, Germany
5
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
6
Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
7
Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
8
Department of Radiotherapy, Outpatient Center, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
9
Department of Radiotherapy, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
10
Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
11
Department of Neurosurgery, University Medical Center Göttingen, 37075 Göttingen, Germany
12
State Institution Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine, 04112 Kyiv, Ukraine
13
Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck, University Medical Center Schleswig-Holstein/Lübeck, 23562 Lübeck, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally.
Cancers 2024, 16(23), 4080; https://doi.org/10.3390/cancers16234080
Submission received: 10 November 2024
/
Revised: 3 December 2024
/
Accepted: 4 December 2024
/
Published: 5 December 2024
(This article belongs to the Section Cancer Therapy)
Simple Summary
Head and neck cancer (HNC) patients often experience serious side effects from treatments like chemotherapy and radiotherapy, which can lead to malnutrition and impact their overall health status. Men and women may face different nutritional challenges during these treatments, potentially affecting their treatment outcomes. This study investigates the gender-specific nutritional status of HNC patients over the course of their treatment, examining differences in body weight, body composition, and their impact on survival. While we found significant declines in albumin and total protein levels in both genders, females exhibited a more notable decrease in albumin levels. Survival analysis revealed that for males, the phase angle, an indicator of cellular health, was linked to survival. For females, albumin levels at the end of treatment were significant predictors of survival.
Abstract
Background/Objectives: This analysis aims to evaluate gender-specific differences in nutritional status, body weight changes, and their impact on overall survival (OS) in head and neck cancer (HNC) patients undergoing (chemo)radiotherapy (CRT). Methods: Between 2018 and 2020, 61 HNC (17 female and 44 male) patients were prospectively recruited to receive curative (chemo)radiotherapy. Nutritional assessments included dietary questionnaire screenings and records, anthropometric methods (body mass index, BMI, body composition via bioelectrical impedance analysis (BIA)), and the determination of biomarkers like albumin and CRP. Assessments were conducted before, during, and after (chemo)radiotherapy. Results: Gender differences were observed at baseline in Karnofsky performance status (p = 0.01), daily calorie intake (p = 0.04), phase angle (PA) (p = 0.003), and fat-free mass index (FFMI) (p < 0.001). During CRT, males showed a larger increase in calorie deficit (p < 0.001) and greater reductions in BMI, FFMI, and PA compared to females. Malnutrition risk (MUST score) increased significantly in males (p = 0.008) but not in females. Albumin and total protein declined in both genders, with a more pronounced drop in albumin for females. Survival analysis revealed that, for males, several factors, including baseline calorie deficit, BMI, PA, and FFMI, were linked to survival. For females, only albumin at therapy end was significantly associated with survival (p < 0.001). In multivariable analysis, baseline PA remained a significant predictor of survival for males (p = 0.026). Conclusions: Our findings suggest distinct gender differences in the nutritional and biochemical responses of HNC patients undergoing CRT, indicating the importance of tailored, gender-specific nutritional support during treatment.
