Weight loss despite nutritional support predicts poor outcomes after postoperative chemoradiotherapy for high-risk head and neck cancer.

PURPOSE: Weight loss is common in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) and is associated with poor prognosis. However, its prognostic significance in patients receiving nutritional support from surgery through postoperative chemoradiotherapy (CRT) remains unclear. We evaluated the impact of treatment-related weight loss on clinical outcomes in this setting. METHODS: This retrospective study included patients with high-risk LA-HNSCC treated with surgery, postoperative CRT, and nutritional intervention. Pre-CRT weight loss was defined as the percentage weight loss between surgery and CRT initiation and analyzed using a 5% cutoff. Associations with recurrence-free survival (RFS), overall survival (OS), and adverse events (AEs) were evaluated. RESULTS: A total of 105 patients were included. Median pre-CRT and overall weight loss were 4.8% and 7.9%, respectively. Patients with recurrence experienced greater pre-CRT weight loss than those without recurrence (6.1% vs. 4.0%, p = 0.004). Patients with ≥ 5% pre-CRT weight loss had significantly worse RFS and OS (log-rank p = 0.001 and p < 0.001). In multivariable analysis, ≥ 5% pre-CRT weight loss remained independently associated with poorer RFS (hazard ratio 2.54, 95% confidence interval 1.35-4.80). The incidence of grade ≥ 3 AEs was comparable between groups (81.8% vs. 86.0%, p = 0.75). CONCLUSION: Pre-CRT weight loss of ≥ 5% was independently associated with poorer RFS in patients with high-risk LA-HNSCC undergoing surgery followed by postoperative CRT despite nutritional intervention. Pre-CRT weight loss may be a simple and clinically useful prognostic marker in this setting.