Unicamp research indicates that body composition and early nutritional support influence survival
In recent years, advances in oncology have shown that understanding cancer goes beyond just looking at the tumor. The nutritional status and body composition of patients, for example, have revealed increasingly relevant factors for the prognosis and response to treatments – especially when it comes to head and neck cancer.
This scenario gains new evidence with the recent publication of 2 works by Fapesp and conducted by researchers from the (Center for Theranostic Innovation in Cancer), one of the Cepids (Research, Innovation and Diffusion Centers) financed by the foundation. CancerThera is based at Hemocentro-Unicamp (Hematology and Hemotherapy Center of the State University of Campinas).
The studies, guided by , were published in international nutrition and clinical oncology journals and investigated the relationship between adiposity (fat deposits), muscularity (amount of muscle mass) and survival in people with head and neck cancer – one of the most complex types of tumor to manage.
Head and neck cancer encompasses a group of tumors that can develop in different regions, such as the mouth, tongue, pharynx, larynx, sinuses and salivary glands. Tumors of the oral cavity (which include lips, oral cavity, salivary glands and oropharynx) represent the 8th most common type of cancer in Brazil, mostly affecting men over 40 years of age – among women, it is not among the ten most common, according to data from Inca (National Cancer Institute).
“Patients with head and neck cancer are one of the most malnourished. This happens because, in addition to issues related to the tumor and the treatment itself, the disease directly affects regions linked to chewing and swallowing, which makes food intake difficult. Naturally, these patients have greater weight loss, more pronounced malnutrition and, therefore, are considered at high nutritional risk”says the nutritionist, co-supervisor of the work and researcher associated with CancerThera.
Although the role of obesity as a risk factor for the development of different cancers is already well established in the literature, the influence of adipose tissue after the disease is established is still an underexplored field. “In cancer there is something called the ‘obesity paradox’. We know that obesity increases the risk of developing various types of tumor, but, in some situations, adipose tissue can act as a protective factor when the patient already has the disease. This is what we also observed in head and neck cancer”says Mendes.
The group’s 1st study in March at Frontiers in Nutrition and analyzed 132 patients with locally advanced head and neck cancer. The team used computed tomography images at the level of C3 (3rd cervical vertebra) to evaluate body composition parameters, such as the total adipose tissue index and the amount of muscle mass.
The results showed that patients with higher levels of adiposity had a reduced risk of mortality compared to those with low levels of fat: individuals with more adipose tissue had a median overall survival of 27.9 months, compared to 13.9 months among those with low levels of fat – twice as long as they lived.
“This data draws attention by confirming that patients with a greater amount of fat in the C3 region had a longer survival rate. This makes us think about the importance of early nutritional therapy. If I identify right at diagnosis that the patient has a low fat reserve, I can intervene more specifically and perhaps increase their survival”declares Mendes.
The findings of this 1st study also showed that the preservation of muscle mass in these patients was an independent protective factor for overall survival. The authors found that patients with a greater amount of muscle mass survived, on average, 22.9 months, while those with low muscle mass lived 8.6 months.
“These results clearly demonstrate the impact of body composition in this group and the importance of also evaluating adipose tissue. They open up new questions for science: what is the impact of adipose tissue metabolism on the prognosis of these patients? Can we reverse this situation and increase the survival of these people with early nutritional support? It is this type of investigation that guides the focus of our laboratory”adds the nutritionist.
Impact on metastatic cancer
The team’s 2nd study, in August at Clinical Nutrition Espenanalyzed another group of 101 patients with metastatic or recurrent head and neck cancer treated at the Hospital de Clínicas da Unicamp and reinforces the relevance of body composition.
Once again, tomography of the C3 cervical region was used to map muscle and fat. The results showed that low muscularity is strongly associated with worse clinical outcomes. “All individuals with low muscle mass died within 24 months of follow-up. On the other hand, some with greater muscularity were still alive after 40 months. This reinforces how it can be decisive for survival”says Mendes.
Together, the findings of the 2 studies draw attention to the need to look at the patient as a whole and incorporate the assessment of body composition into clinical care. According to the researcher, evaluation using tomography scans (which are performed routinely) facilitates this type of analysis, making it accessible to the majority of cancer patients.
“Most studies only look at muscle. The difference in our research was to also include adipose tissue, and we found very relevant results. However, it is not just the amount of fat that matters, but also your metabolism and how it can provide valuable information during treatment”says Mendes.
In the researcher’s opinion, the contribution of these studies is significant as it opens up space for new therapeutic strategies that consider the interaction between muscle, fat and cancer. “The idea is to reinforce what we already know: monitoring nutrition is essential. But this often ends up being neglected in practice. We want to show that the assessment of body composition should be incorporated routinely, because it can make a difference in the time and quality of life of these patients”says Mendes.
With information from . Text written by Fernanda Bassette.
