Nutrition during trimodality treatment in stage III non-small cell lung cancer: Not only important for underweight patients

Trimodality treatment for stage III non-small cell lung cancer (NSCLC), consisting of chemoradiotherapy followed by surgery, is associated with treatment-related toxicity, malnutrition, and postoperative complications. The aim of this retrospective study was to investigate the predictive value of nutritional parameters on postoperative morbidity, mortality, and survival. Methods: Patients with stage III NSCLC undergoing concurrent chemoradiotherapy followed by surgery in one center between 2003 and 2009 were included. Age, sex, forced expiratory volume in 1 second, body mass index, weight change, and surgical and pathological factors were recorded and related to the occurrence of postoperative complications/mortality, overall survival (OS), and progression-free survival. Results: Of 51 study patients, 17 (33%) had overweight (body mass index ≥ 25) at start of treatment and 20 patients (39%) were malnourished at hospital admission for surgery. Postoperative complications occurred in 25 patients (49%), 6 had major complications, and 2 died within 90 days after surgery, but no significant predictive factors were found. Overall, weight loss ≥5% during induction period was associated with shorter OS (p = 0.03), but especially overweight patients experiencing weight loss ≥5% during induction period (n = 7) had shorter OS (hazard ratio 4.63, p = 0.005; log-rank p = 0.04) and progression-free survival (hazard ratio 6.03, p = 0.007). Conclusions: This study indicates that malnutrition especially in overweight patients negatively influences survival outcomes of trimodality treatment for stage III NSCLC.