{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:16:47Z","timestamp":1778771807768,"version":"3.51.4"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Importance<\/jats:title>\n Malnutrition, common in patients with head and neck squamous cell carcinoma (HNSCC), may impair the effectiveness of immunotherapy. Understanding whether nutritional status affects outcomes can emphasize the importance of pretreatment nutritional optimization.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the associations of body mass index (BMI), pretreatment BMI change, and prognostic nutritional index (PNI) with progression-free survival (PFS) in patients with advanced HNSCC treated with immunotherapy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Cohort study using deidentified electronic health records from the Flatiron Health database between January 2014 to January 2024, with follow-up of 3000 days in multiple cancer institutions across the US. Patients were from community and academic practices in the US, diagnosed with all types of advanced head and neck cancer who received immunotherapy (nivolumab, pembrolizumab, cemiplimab, durvalumab, atezolizumab, avelumab, or ipilimumab) between January 2014 and January 2024. Exclusion criteria included age younger than 18 years, patients without a diagnosis of squamous cell carcinoma, missing stage information, missing treatment information (eg, a gap in documented care of \u226590 days or more), and incomplete data needed to calculate BMI or PNI prior to initiation of therapy.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Baseline BMI, pretreatment BMI change (\u22652% decrease vs stable), and PNI (low &amp;lt;45 vs normal \u226545).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n PFS following treatment with immunotherapy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1108 patients (mean [SD] age, 66.2 [10.2] years; 236 [21.3%] female; 872 [78.7%] male), 214 (79%) experienced 2% or more pretreatment BMI loss. BMI loss was associated with worse PFS (hazard ratio, 1.17; 95% CI, 1.02-1.35); median PFS was 271 (IQR, 121-603) days with loss vs 415 days with stable BMI. In the 471 patients with laboratory data, 320 (67.9%) had a low PNI. Low PNI was associated with shorter PFS (adjusted hazard ratio, 1.58; 95% CI, 1.39-1.79); median PFS was 213 (IQR, 98-445) days for low vs 566 (IQR, 307-1094) days for patients with a normal PNI. Baseline BMI category was not independently associated with PFS.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this large, nationally representative cohort of patients with advanced head and neck squamous cell carcinoma treated with immunotherapy, pretreatment BMI loss and low PNI were independently associated with PFS, while baseline BMI was not. These findings suggest that dynamic measures of nutrition and immune status provide more meaningful prognostic information than static measures. Nutritional optimization may represent a modifiable factor to improve outcomes in patients receiving immunotherapy for advanced head and neck squamous cell carcinoma.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.0166","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T15:30:23Z","timestamp":1775143823000},"page":"523","source":"Crossref","is-referenced-by-count":0,"title":["Body Mass Index and Nutritional Status With Immunotherapy Response in Head and Neck Cancer"],"prefix":"10.1001","volume":"152","author":[{"given":"Lauren","family":"Gabra","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra","family":"Nitsch","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center School of Health Professions, Austin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science, Southern Methodist University, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Lun","family":"Liu","sequence":"additional","affiliation":[{"name":"Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Truelson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larry L.","family":"Myers","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittny","family":"Tillman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lenka","family":"Stankova","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Sher","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainab","family":"Farzal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Swiatowiec","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randall","family":"Hughes","sequence":"additional","affiliation":[{"name":"Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Cao","sequence":"additional","affiliation":[{"name":"Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baran D.","family":"Sumer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"2","key":"ooi260010r1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/jop.13513","article-title":"Epigenetics in the diagnosis and prognosis of head and neck cancer: a systematic review.","volume":"53","author":"Lim","year":"2024","journal-title":"J Oral Pathol Med"},{"issue":"1","key":"ooi260010r2","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1056\/NEJMra1715715","article-title":"Head and neck cancer.","volume":"382","author":"Chow","year":"2020","journal-title":"N Engl J Med"},{"issue":"1","key":"ooi260010r3","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/s41392-022-01297-0","article-title":"Targeted therapy for head and neck cancer: signaling pathways and clinical studies.","volume":"8","author":"Li","year":"2023","journal-title":"Signal Transduct Target Ther"},{"issue":"3","key":"ooi260010r4","doi-asserted-by":"publisher","first-page":"203","DOI":"10.3322\/caac.21343","article-title":"American Cancer Society head and neck cancer survivorship care guideline.","volume":"66","author":"Cohen","year":"2016","journal-title":"CA Cancer J Clin"},{"issue":"4","key":"ooi260010r5","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1002\/hed.25025","article-title":"AHNS series: do you know your guidelines? principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma.","volume":"40","author":"Fulcher","year":"2018","journal-title":"Head Neck"},{"issue":"7","key":"ooi260010r6","doi-asserted-by":"publisher","first-page":"873","DOI":"10.6004\/jnccn.2020.0031","article-title":"Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology.","volume":"18","author":"Pfister","year":"2020","journal-title":"J Natl Compr Canc Netw"},{"issue":"3","key":"ooi260010r7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"5","key":"ooi260010r8","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1200\/JCO.22.02328","article-title":"Immunotherapy and biomarker testing in recurrent and metastatic head and neck cancers: ASCO guideline.","volume":"41","author":"Yilmaz","year":"2023","journal-title":"J Clin Oncol"},{"issue":"9","key":"ooi260010r9","doi-asserted-by":"publisher","first-page":"2691","DOI":"10.3390\/cancers12092691","article-title":"Immunotherapy breakthroughs in the treatment of recurrent or metastatic head and neck squamous cell carcinoma.","volume":"12","author":"Borel","year":"2020","journal-title":"Cancers (Basel)"},{"issue":"4","key":"ooi260010r10","doi-asserted-by":"publisher","first-page":"703","DOI":"10.3390\/cancers16040703","article-title":"Mechanisms of resistance and therapeutic perspectives in immunotherapy for advanced head and neck cancers.","volume":"16","author":"Meci","year":"2024","journal-title":"Cancers (Basel)"},{"issue":"8","key":"ooi260010r11","doi-asserted-by":"publisher","DOI":"10.1172\/JCI188128","article-title":"Immunotherapeutic strategies in head and neck cancer: challenges and opportunities.","volume":"135","author":"Liu","year":"2025","journal-title":"J Clin Invest"},{"issue":"8","key":"ooi260010r12","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1007\/s00262-021-02858-y","article-title":"The predictive value of body mass index on prognosis and adverse events of cancers treated with immunotherapy: a systematic review and meta-analysis.","volume":"70","author":"You","year":"2021","journal-title":"Cancer Immunol Immunother"},{"issue":"1","key":"ooi260010r13","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s12967-020-02404-x","article-title":"Association between body mass index and survival outcomes for cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis.","volume":"18","author":"An","year":"2020","journal-title":"J Transl Med"},{"issue":"12","key":"ooi260010r14","doi-asserted-by":"publisher","first-page":"2413","DOI":"10.1007\/s00262-020-02680-y","article-title":"Pretreatment body mass index and clinical outcomes in cancer patients following immune checkpoint inhibitors: a systematic review and meta-analysis.","volume":"69","author":"Chen","year":"2020","journal-title":"Cancer Immunol Immunother"},{"issue":"8","key":"ooi260010r15","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1001\/jamaoto.2024.1568","article-title":"Obesity and survival after immune checkpoint inhibition for head and neck squamous cell carcinoma.","volume":"150","author":"Mastrolonardo","year":"2024","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"22","key":"ooi260010r16","doi-asserted-by":"publisher","first-page":"5772","DOI":"10.3390\/cancers13225772","article-title":"Nutritional status as a predictive biomarker for immunotherapy outcomes in Advanced Head and Neck Cancer.","volume":"13","author":"Guller","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"10","key":"ooi260010r17","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1080\/00016489.2023.2288910","article-title":"Prognostic significance of nutritional indices in patients with head and neck squamous cell carcinoma treated with immune checkpoint inhibitors.","volume":"143","author":"Miyamoto","year":"2023","journal-title":"Acta Otolaryngol"},{"issue":"2","key":"ooi260010r18","doi-asserted-by":"publisher","DOI":"10.1002\/cnr2.70147","article-title":"BMI association with treatment outcomes in head and neck cancer patients receiving immunotherapy: a comprehensive review and meta-analysis.","volume":"8","author":"Saowapa","year":"2025","journal-title":"Cancer Rep (Hoboken)"},{"issue":"6","key":"ooi260010r19","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.3390\/nu14061268","article-title":"Efficacy of the nutritional risk index, geriatric nutritional risk index, BMI, and GLIM-defined malnutrition in predicting survival of patients with head and neck cancer patients qualified for home enteral nutrition.","volume":"14","author":"Przekop","year":"2022","journal-title":"Nutrients"},{"issue":"7","key":"ooi260010r20","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1002\/lary.29353","article-title":"Factors associated with lymph node count in mucosal squamous cell carcinoma neck dissection.","volume":"131","author":"Bhalli","year":"2021","journal-title":"Laryngoscope"},{"key":"ooi260010r21","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaa166.1094","article-title":"Body mass index at diagnosis and prognostic significance on head and neck carcinoma survival.","volume":"\u2022\u2022\u2022","author":"Pastorino","year":"2020","journal-title":"Eur J Public Health"},{"issue":"4","key":"ooi260010r22","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1002\/hed.28006","article-title":"Nodal yield from neck dissection predicts the anti-tumor immune response in head and neck cancers.","volume":"47","author":"Chen","year":"2025","journal-title":"Head Neck"},{"issue":"5","key":"ooi260010r23","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.3390\/nu12051225","article-title":"Changes in nutrition impact symptoms, nutritional and functional status during head and neck cancer treatment.","volume":"12","author":"Neoh","year":"2020","journal-title":"Nutrients"},{"issue":"6","key":"ooi260010r25","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1007\/s00520-014-2500-0","article-title":"NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients.","volume":"23","author":"Orell-Kotikangas","year":"2015","journal-title":"Support Care Cancer"},{"issue":"8","key":"ooi260010r26","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1002\/jpen.2688","article-title":"Malnutrition risk screening in adult oncology outpatients: an ASPEN systematic review and clinical recommendations.","volume":"48","author":"Trujillo","year":"2024","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"1","key":"ooi260010r27","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1186\/s12967-021-03144-2","article-title":"The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study.","volume":"19","author":"Cristofaro","year":"2021","journal-title":"J Transl Med"},{"issue":"9","key":"ooi260010r28","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1002\/mc.23584","article-title":"The relationship of nutritional status with anticancer immunity and its prognostic value for head and neck cancer.","volume":"62","author":"Chen","year":"2023","journal-title":"Mol Carcinog"},{"key":"ooi260010r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2023.106364","article-title":"Nutritional status associates with immunotherapy clinical outcomes in recurrent or metastatic head and neck squamous cell carcinoma patients.","volume":"140","author":"Hernando-Calvo","year":"2023","journal-title":"Oral Oncol"},{"issue":"4","key":"ooi260010r31","doi-asserted-by":"publisher","first-page":"880","DOI":"10.3390\/nu15040880","article-title":"The geriatric nutritional risk index (GNRI) as a prognostic biomarker for immune checkpoint inhibitor response in recurrent and\/or metastatic head and neck cancer.","volume":"15","author":"Haas","year":"2023","journal-title":"Nutrients"},{"key":"ooi260010r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.106018","article-title":"Predictive significance of body composition indices in patients with head and neck squamous cell carcinoma treated with nivolumab: a multicenter retrospective study.","volume":"132","author":"Takenaka","year":"2022","journal-title":"Oral Oncol"},{"key":"ooi260010r33","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.ejca.2023.01.030","article-title":"Survival and immunotoxicities in association with sex-specific body composition patterns of cancer patients undergoing immune-checkpoint inhibitor therapy - a systematic review and meta-analysis.","volume":"184","author":"Trinkner","year":"2023","journal-title":"Eur J Cancer"},{"key":"ooi260010r30","first-page":"e001675corr1","article-title":"Correction: Baseline prognostic nutritional index and changes in pretreatment BMI associate with immunotherapy response in patients with advanced cancer.","volume-title":"J Immunother Cancer","year":"2021"},{"key":"ooi260010r24","doi-asserted-by":"crossref","unstructured":"Ma? X, Long? L, Moon? S, Adamson? BJS, Baxi? SS. Comparison of population characteristics in real-world clinical oncology databases in the US: Flatiron Health, SEER, and NPCR.? medRxiv. Preprint posted online January 1, 2023. doi:10.1101\/2020.03.16.20037143","DOI":"10.1101\/2020.03.16.20037143"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2847178\/jamaotolaryngology_gabra_2026_oi_260010_1778044134.75303.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:00:18Z","timestamp":1778770818000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2847178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2026.0166","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}