Nutritional surveillance from surgery to post-radiotherapy in oral cavity cancer: a prospective longitudinal study

This prospective longitudinal study evaluated nutritional changes in patients with oral cavity cancer undergoing multimodal treatment and examined the impact of nutritional status on clinically meaningful outcomes, including mortality and 30-day readmissions.

One hundred patients undergoing surgery followed by radiotherapy were assessed at five time points (V0-V4). Nutritional evaluations included body weight, body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip strength (HGS), serum albumin, and dietary intake. Primary outcomes were mortality 30-day readmissions and mucositis severity. Secondary outcomes included length of hospital stay (LOHS), and radiotherapy compliance. Statistical analyses included repeated-measures ANOVA, chi-square tests, logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards modeling.

Significant declines in weight, BMI, fat mass, muscle mass, and HGS occurred throughout treatment (p < 0.01), with the greatest deterioration during radiotherapy. Weight loss > 5% was associated with severe mucositis (p < 0.05), and low muscle mass was associated with longer LOHS (p < 0.05). Hypoalbuminemia (< 3.5 g/dL) predicted higher mortality (41.7% vs. 12.5%) and 30-day readmissions (50.0% vs. 13.6%). Lower albumin and reduced muscle mass showed trends toward poorer survival on Kaplan-Meier analysis; however, these differences did not reach statistical significance.

Nutritional deterioration is progressive and clinically significant in oral cavity cancer and directly influences mortality and readmissions. Early identification of at-risk patients and structured, multimodal nutritional surveillance are essential. Standardized primary outcomes and robust statistical modeling strengthen clinical relevance and provide a methodological framework for designing future nutritional intervention trials.