The prognostic value of weight loss during radiotherapy among patients with nasopharyngeal carcinoma: a large-scale cohort study

Abstract

Background: We aim to investigate the prognostic value of weight loss during radiotherapy (RT) among patients with nasopharyngeal carcinoma (NPC).

Methods: A total of 1149 NPC patients who received radical RT were retrospectively analyzed. Patients' weight were measured at initiation of RT (W_Pre-RT) and every week during RT (W_{RT1,2,3,4,5,6,7}). Percentage of weight loss (PWL) at 1st, 2nd, 3rd, 4th, 5th, 6th, and 7th week of RT (RT-PWL_{1,2,3,4,5,6,7}) were calculated using the following equation: (W_Pre-RT -W_{RT1,2,3,4,5,6,7})/W_Pre-RT × 100%. The optimal threshold of RT-PWL₇ was determined by recursive partitioning analyses (RPAs). Our endpoints included disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS).

Results: The median RT-PWLs were 0, 0, 1.5, 2.9, 4.1, 5.5, 6.6% at 1st, 2nd, 3rd, 4th, 5th, 6th, and 7th week of RT, respectively. RT-PWL₇ optimal threshold with respect to DFS was 5.3% based on RPAs. Therefore, a consistent threshold of 5% (<5% vs > ≥5%) was selected to classify NPC patients into low RT-PWL₇ and high RT-PWL₇ groups for survival analysis. Compared to high RT-PWL₇ (≥5%), patients with low RT-PWL₇ (< 5%) had significantly better ten-year DFS (61.2% vs 78.8%; P < 0.001), OS (70.1% vs 86.6%; P < 0.001), and DMFS (80.2% vs 88.5%; P = 0.007). However, no difference was observed between LRRFS groups (91.7% vs 94.3%; P = 0.173). In multivariate analysis, high RT-PWL₇ was an independent risk factor for DFS (HR, 1.56; 95%CI, 1.19-2.03; P = 0.001), OS (HR, 1.54; 95%CI, 1.11-2.15; P = 0.011), and DMFS (HR, 1.47; 95%CI, 1.03-2.10; P = 0.033) in patients with NPC. In addition, treatment strategy, plasma Epstein-Barr virus DNA, and N stage were associated with weight loss.

Conclusions: High RT-PWL₇ was significantly associated with decreased DFS, OS, and DMFS for NPC patients. Clinicians should continuously inform patients on the health impact of minimizing RT-PWL₇ under 5% during radiotherapy.

Keywords: Nasopharyngeal carcinoma; Prognostic value; Radiotherapy; Survival; Weight loss.

Fig. 1

Downward trends in weight loss at every week during radiotherapy among patients with nasopharyngeal carcinoma

Fig. 2

Comparison between the RT-PWL₇ < 5% group and the RT-PWL₇ ≥ 5% group for A disease-free survival, B overall survival, C distant metastasis-free survival, and D locoregional relapse-free survival. RT-PWL₇, percentage of weight loss at week 7 of radiotherapy (RT)

Fig. 3

Comparison between the NAC-PWL < 5% group and the NAC-PWL ≥ 5% group for A disease-free survival, B overall survival, C distant metastasis-free survival, and D locoregional relapse-free survival. NAC-PWL: percentage of weight loss during neoadjuvant chemotherapy (NAC)