The Body Mass Index Paradox in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Epidemiology
• Biostatistics

Background:

• The body mass index (BMI) paradox is observed in various cancers, where elevated BMI correlates with better patient survival.
• Head and neck squamous cell carcinoma (HNSCC) survival outcomes may be influenced by patient body mass index (BMI).

Approach:

• A systematic literature search identified studies reporting hazard ratios for BMI's impact on overall survival (OS) in HNSCC patients.
• Meta-analysis using random-effects DerSimonian and Laird methods synthesized data from included studies.

Key Points:

• Overweight patients (BMI 25–30 kg/m²) exhibited significantly lower hazards of death compared to normal weight individuals (BMI 18.5–25 kg/m²).
• This survival benefit associated with overweight status diminished for BMIs exceeding 30 kg/m².
• Underweight patients (BMI < 18.5 kg/m²) faced increased hazards of death relative to normal weight HNSCC patients.

Conclusions:

• Pretreatment overweight status (BMI up to 30 kg/m²) is a positive predictor of overall survival in HNSCC patients.
• Underweight status presents a prognostic disadvantage for HNSCC patients.
• Further research is required to elucidate the biological mechanisms underlying the association between body mass and survival in HNSCC.