Percutaneous endoscopic gastrostomy improves survival and nutritional outcomes in patients with head and neck cancer

Abstract

Percutaneous endoscopic gastrostomy (PEG) placement is used for maintaining nutritional status. We aimed to compare overall survival, body weight, and albumin changes between PEG and non-PEG groups. This retrospective cohort study was conducted at Songklanagarind Hospital, Southern Thailand, which included patients (aged ≥ 18 years) with head and neck cancer (HNC) diagnosed between 2007 and 2022. We used the nearest neighbor search to conduct the propensity score matching (PSM) in a 1:1 ratio. Of the 5024 eligible patients, 1604 (31.9%) underwent PEG. After PSM for age, sex, body mass index, type of HNC, time of diagnosis, stage, hemoglobin, albumin and total lymphocyte count, the final PEG and non-PEG groups each included 1,361 patients. The most common cancer type was stage 4 nasopharyngeal cancer. Patients with PEG showed a median survival time of 2.33 (95% confidence interval [CI] 2.15–2.65) years, which was significantly longer than that in the non-PEG group (1.04 [95% CI 0.97–1.10] years; p < 0.0001). The PSM results were similar, whereby patients with PEG showed a greater median survival time of 2.10 (95% CI 1.87–2.32) years compared to those without PEG (1.11 [95% CI 1.03–1.21] years; p < 0.0001). Patients who underwent PEG also showed significant reductions in the loss of body weight and albumin. Multivariable analysis demonstrated that PEG placement was a significant factor for improved 3-month survival (adjusted hazard ratio: 0.24, 95% CI 0.17–0.34). In patients with HNCs, PEG placement improved survival and resulted in a reduced loss of weight and albumin.