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. 2024 Nov 3;4(6):789-796.
doi: 10.21873/cdp.10397. eCollection 2024 Nov-Dec.

Prediction of Treatment Response Based on Nutritional Status and Tumor Immunity in Oropharyngeal Cancer Patients Treated With Chemoradiotherapy

Mio Kitagawa  1 , Juno Kaguchi  1 , Masanori Someya  1 , Yuki Fukushima  1 , Tomokazu Hasegawa  1 , Takaaki Tsuchiya  1 , Toshio Gocho  1 , Shoh Mafune  1 , Yutaro Ikeuchi  1 , Ryu Okuda  1 , Atsuya Ohguro  1 , Ryo Kamiyama  1 , Ayato Ashina  1 , Yuka Toshima  1 , Yoshihiko Hirohashi  2 , Toshihiko Torigoe  2 , Koh-Ichi Sakata  1
Affiliations

Prediction of Treatment Response Based on Nutritional Status and Tumor Immunity in Oropharyngeal Cancer Patients Treated With Chemoradiotherapy

Mio Kitagawa et al. Cancer Diagn Progn. .

Abstract

Background/aim: Radiotherapy (RT) for advanced oropharyngeal cancer (OPC) is effective, especially when combined with chemotherapy (CRT). However, its success can vary depending on factors, such as tumor stage, HPV infection (p16 status), and the patient's nutritional and immune status. This study examined the controlling nutritional status (CONUT) score and tumor immunity as predictive factors for treatment outcomes in OPC, aiming to develop a personalized risk score.

Patients and methods: A retrospective analysis was conducted on 84 patients with OPC treated with definitive RT or CRT, and survival outcomes were compared based on various factors, including BMI, CONUT score, CD8 expression, and HLA class II expression.

Results: We observed better overall survival (OS) rates in CD8-positive patients and those with higher HLA class II expression. The univariate analysis identified stage, p16 status, BMI, CONUT score, and CD8 expression as significantly associated with OS. In multivariate analysis, stage, BMI, and CONUT score remained significant predictors of OS. A risk scoring system was developed based on stage, p16 status, BMI, CONUT score, and CD8 expression. Patients were categorized into low-risk and high-risk groups, with significantly better survival in the low-risk group.

Conclusion: A combined risk score incorporating clinical, nutritional, and immune factors can improve the prediction of treatment outcomes for OPC patients. This risk stratification may enable personalized treatment plans and improve ΟS rates.

Keywords: CD8; CONUT score; Forkhead box P3; Human leukocyte antigen class II; Oropharyngeal cancer; body mass index; chemotherapy; radiotherapy.

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Conflict of interest statement

The Authors declare that they have no conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1
Representative images of immunohistochemically stained biopsy specimens with positive cases. (A) CD8 positive lymphocytes infiltrating around tumor nest, (B) FoxP3 positive lymphocytes infiltrating around tumor nest, (C) HLA class II positive tumor cells.
Figure 2
Figure 2
Overall survival according to tumor stage.
Figure 3
Figure 3
Overall survival according to the expression of proteins. (A) CD8 positive vs. negative (p=0.019); (B) FoxP3 positive vs. negative (p=0.667); (C) HLA class II positive vs. negative (p=0.082).
Figure 4
Figure 4
Overall survival stratified by the combined risk score; low-risk group (score 0-2) vs. high-risk group (score 3-7) (p<0.001).
Figure 5
Figure 5
The ROC curves of prediction for overall survival. A dotted line indicates ROC curve for combinations of clinical parameters (Stage and p16 status). A solid line shows ROC curve for combinations of all parameters (Stage, p16 status, BMI, CONUT score, and CD8 positivity).
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