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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Body Mass Index and Nutritional Dynamics as Predictors of Survival in Patients with Oropharyngeal Squamous Cell Carcinoma Undergoing Chemoradiation

  • Julian Emanuel Bonea1
  • Monica Emilia Chirila2,3
  • Renata Zahu2,3
  • Nicolae Todor4
  • Ștef Ionuț Andrei5
  • Daniela Elena Sturzu3
  • Andrei Țenț6
  • Vlad Manolescu7
  • Gabriel Kacsó2,3,8
8 affiliations
  1. 1Department of Human Anatomy and Embriology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
  2. 2Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
  3. 3Department of Radiation Oncology, Amethyst Radiotherapy Center Cluj, 407280 Floresti, Romania
  4. 4Department of Statistics, Ion Chiricuta Institute of Oncology, 400015 Cluj-Napoca, Romania
  5. 5General Medicine Faculty, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
  6. 6Department of Oral and Maxillo-Facial Surgery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
  7. 7Department of Medical Oncology, Amethyst Radiotherapy Center Cluj, 407280 Floresti, Romania
  8. 8Department of Medical Oncology, Emergency County Hospital, 400347 Cluj-Napoca, Romania
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Abstract

Background/Objective: Body mass index (BMI) and treatment-related weight variation have been increasingly investigated as potential prognostic factors in head and neck oncology. However, their role in patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing concomitant chemoradiation (CRT) remains incompletely defined, particularly in real-world Eastern European populations. The aim of this study was to evaluate the prognostic significance of pretreatment BMI and treatment-induced weight variation in patients with OPSCC treated with curative-intent CRT and to assess their association with survival outcomes. Methods: This single-centre retrospective cohort study evaluated consecutive patients with OPSCC treated with CRT at a Romanian regional oncology centre between 2015 and 2023. Key exclusions were prior surgery or neoadjuvant chemotherapy, palliative care, and secondary malignancies. Clinical variables, baseline comorbidity burden (via Age-Adjusted Charlson Comorbidity Index), and body mass index (BMI) dynamics across treatment timepoints—including pre- and post-CRT BMI, ΔBMI during CRT, and weight loss thresholds ≥5% and ≥10%—were assessed. Overall survival (OS) was analysed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards multivariate regression to determine independent prognostic factors (p <0.05). Results: Among 114 patients analysed (median age 61; 80.7% male; median follow-up 52 months), 55.2% experienced ≥5% weight loss during chemoradiotherapy (CRT), and 22.8% lost ≥10%. On univariate analysis, significant predictors of reduced 5-year overall survival (OS) included age ≥65 years (HR 2.47, p = 0.01), CRT duration ≥ 47 days (63.2% vs. 92.3%; HR 2.52, p = 0.05), weight loss ≥ 10% (50.0% vs. 71.6%; HR 2.28, p = 0.03), pre-CRT BMI < 24 kg/m2 (HR 0.50, p = 0.04), post-CRT BMI < 24 kg/m2 (HR 0.40, p < 0.01), and a BMI reduction > 6% (HR 0.50, p = 0.03). On multivariate Cox regression, only age at diagnosis and CRT treatment duration were validated as independent prognostic factors for OS. Conclusions: Weight loss during concomitant CRT and low body mass index were associated with impaired 5-year OS in patients with oropharyngeal squamous cell carcinoma. However, after multivariate adjustment, age at diagnosis, and treatment duration were the sole independent prognostic factors.

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Cite

BibTeXRIS
BibTeX
@article{bonea2026body,
  title = {{Body Mass Index and Nutritional Dynamics as Predictors of Survival in Patients with Oropharyngeal Squamous Cell Carcinoma Undergoing Chemoradiation}},
  author = {Julian Emanuel Bonea and Monica Emilia Chirila and Renata Zahu and Nicolae Todor and Ștef Ionuț Andrei and Daniela Elena Sturzu and Andrei Țenț and Vlad Manolescu and Gabriel Kacsó},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208142},
  url = {https://www.mdpi.com/2077-0383/15/20/8142},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Body Mass Index and Nutritional Dynamics as Predictors of Survival in Patients with Oropharyngeal Squamous Cell Carcinoma Undergoing Chemoradiation
AU  - Julian Emanuel Bonea
AU  - Monica Emilia Chirila
AU  - Renata Zahu
AU  - Nicolae Todor
AU  - Ștef Ionuț Andrei
AU  - Daniela Elena Sturzu
AU  - Andrei Țenț
AU  - Vlad Manolescu
AU  - Gabriel Kacsó
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208142
UR  - https://www.mdpi.com/2077-0383/15/20/8142
AB  - Background/Objective: Body mass index (BMI) and treatment-related weight variation have been increasingly investigated as potential prognostic factors in head and neck oncology. However, their role in patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing concomitant chemoradiation (CRT) remains incompletely defined, particularly in real-world Eastern European populations. The aim of this study was to evaluate the prognostic significance of pretreatment BMI and treatment-induced weight variation in patients with OPSCC treated with curative-intent CRT and to assess their association with survival outcomes. Methods: This single-centre retrospective cohort study evaluated consecutive patients with OPSCC treated with CRT at a Romanian regional oncology centre between 2015 and 2023. Key exclusions were prior surgery or neoadjuvant chemotherapy, palliative care, and secondary malignancies. Clinical variables, baseline comorbidity burden (via Age-Adjusted Charlson Comorbidity Index), and body mass index (BMI) dynamics across treatment timepoints—including pre- and post-CRT BMI, ΔBMI during CRT, and weight loss thresholds ≥5% and ≥10%—were assessed. Overall survival (OS) was analysed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards multivariate regression to determine independent prognostic factors (p <0.05). Results: Among 114 patients analysed (median age 61; 80.7% male; median follow-up 52 months), 55.2% experienced ≥5% weight loss during chemoradiotherapy (CRT), and 22.8% lost ≥10%. On univariate analysis, significant predictors of reduced 5-year overall survival (OS) included age ≥65 years (HR 2.47, p = 0.01), CRT duration ≥ 47 days (63.2% vs. 92.3%; HR 2.52, p = 0.05), weight loss ≥ 10% (50.0% vs. 71.6%; HR 2.28, p = 0.03), pre-CRT BMI < 24 kg/m2 (HR 0.50, p = 0.04), post-CRT BMI < 24 kg/m2 (HR 0.40, p < 0.01), and a BMI reduction > 6% (HR 0.50, p = 0.03). On multivariate Cox regression, only age at diagnosis and CRT treatment duration were validated as independent prognostic factors for OS. Conclusions: Weight loss during concomitant CRT and low body mass index were associated with impaired 5-year OS in patients with oropharyngeal squamous cell carcinoma. However, after multivariate adjustment, age at diagnosis, and treatment duration were the sole independent prognostic factors.
SN  - 2077-0383
ER  -