Association of Nutritional Status with Quality of Life in Nasopharyngeal Carcinoma: Development of a Nomogram for Early Identification of Severe Malnutrition

Objective: To investigate the relationship between nutritional status and quality of life (QoL) among hospitalized patients with nasopharyngeal carcinoma (NPC), analyze the influencing factors of malnutrition, and develop a predictive nomogram model for severe malnutrition to inform clinical nutritional support strategies. Methods: This retrospective study included NPC patients admitted to the Department of Head and Neck Oncology from January 1, 2014 to December 31, 2019. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS 2002), while nutritional status was evaluated via the Patient-Generated Subjective Global Assessment (PG-SGA). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30 v3.0) was used to assess QoL. Logistic regression was employed to identify independent risk factors for severe malnutrition (PG-SGA ≥ 9), and a clinical nomogram model was constructed and validated. Results: A total of 216 NPC patients were included (77.78% male; mean age 50.5 ± 10.58 years). Nutritional screening showed 26.85% had nutritional risk (NRS 2002 ≥ 3), and nutritional assessment revealed that 23.15% had severe malnutrition. Physical measurements, biochemical indicators (including BMI, TSF, MAC, handgrip strength, prealbumin, urea nitrogen), and QoL scores significantly differed among groups with varying nutritional status (p < 0.05), with worsening nutrition associated with poorer outcomes. PG-SGA scores were negatively correlated with QoL function and global health scores, but positively with symptom burden (p < 0.05).Univariate analysis identified age ≥ 65 years, nutritional risk (NRS 2002 ≥ 3), and pain as risk factors for severe malnutrition, while higher KPS score, BMI, and prealbumin were protective. Multivariate analysis confirmed NRS 2002 (OR = 17.14, p < 0.001), KPS (OR = 0.91, p = 0.004), and pain (OR = 2.79, p = 0.002) as independent predictors. A nomogram incorporating these variables demonstrated excellent predictive performance (AUC = 0.903 in training set; 0.825 in validation set), with good calibration and clinical utility per decision curve analysis (DCA). Conclusion: Malnutrition is prevalent in hospitalized NPC patients and is associated with poorer QoL. The predictive nomogram based on NRS 2002, KPS score, and pain score provides a reliable tool for early identification of patients at risk for severe malnutrition, supporting timely and personalized nutritional intervention.