Association of loss of visceral adipose tissue after concurrent chemoradiotherapy with poor survival in patients with head and neck squamous cell carcinoma

Abstract

Objectives: Nutritional status is known to be associated with clinical outcomes in head and neck squamous cell carcinoma (HNSCC) patients. The aim of this study was to investigate whether changes in subcutaneous (SAT) and visceral (VAT) adipose tissue mass after concurrent chemoradiotherapy (CCRT) are significantly related to progression-free survival (PFS) and overall survival (OS) in HNSCC patients.

Methods: 117 HNSCC patients who underwent definitive CCRT were retrospecitively analyzed. Using unenhanced computed tomography images from pretreatment (PET1) and 3 months post-CCRT (PET2) F-18 fluorodeoxyglucose positron emission tomography (PET)/computed tomography scans, we measured the cross-sectional areas of SAT and VAT. The areas of SAT and VAT were adjusted for height squared to calculate the SAT and VAT indices.

Results: Following CCRT, 92 patients (78.6%) exhibited a decrease in VAT index values. The complete metabolic response (CMR) patient group showed significantly higher values of VAT index at PET2 compared to the non-CMR group (P < 0.05). Multivariate survival analysis found that the VAT index at PET2 and the percent changes in both the SAT index and VAT index were significant predictors for both PFS and OS (P < 0.05). Patients with a low VAT index at PET2 and marked losses of SAT index and VAT index after CCRT had poorer survival outcomes. On subgroup survival analysis, the percent change in VAT index was a significant predictor for PFS and OS in both CMR and non-CMR groups (P < 0.05).

Conclusions: The alteration in VAT mass after CCRT was clinically significant for risk stratification of survival outcomes in HNSCC patients.