The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study
The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study
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头颈癌患者口腔念珠菌病与放化疗引起的吞咽困难严重程度之间的关联：一项回顾性队列研究
DOI：
10.1016/j.ctro.2019.10.006
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发表时间：
2020
影响因子：
3.1
通讯作者：
Hidefumi Aoyama
中科院分区：
文献类型：
--
作者：
Hirotake Saito;Ryusuke Shodo;Keisuke Yamazaki;Kouji Katsura;Yushi Uek;Toshimichi Nakano;Tomoya Oshikane;Nobuko Yamana;Satoshi Tanabe;Satoru Utsunomiya;Atsushi Ohta;Eisuke Abe;Motoki Kaidu;Ryuta Sasamoto;Hidefumi Aoyama
头颈癌的同期放化疗(CCRT)是口腔念珠菌病(OC)的危险因素。作为Candidaspp。我们进行了一项回顾性研究，以确定OC是否增加了HNC患者与粘膜炎相关的吞咽困难的严重程度。患者和方法我们回顾分析了在本院连续接受含顺铂(CDDP)的CCRT的口腔、咽和喉癌患者。OC的诊断以大体粘膜表现为依据。我们进行了多变量分析，以确定OC是否与放射治疗肿瘤组(RTOG)急性毒性标准中3级吞咽困难的发生有关。比较有无强迫症患者每日阿片类药物的最大剂量。51例(37%)患者出现OC。到他们被诊断为OC时，19例(37%)已经发展为3级吞咽困难。在接受抗真菌治疗的30名患者中，12名(40%)出现了临床恶化。在多因素分析中，OC与3级吞咽困难独立相关(OR2.75；95%CI1.22~6.23；p = 0.015)。OC患者需要相当于吗啡的阿片类药物剂量(45 mg/d比30 = mg/d，p<0.029)。结论念珠菌感染可导致难治性吞咽困难。抗真菌预防是否能减少与念珠菌病相关的严重吞咽困难是值得研究的。
Background and purposeConcurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). AsCandidaspp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients.Patients and methodsWe retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC.ResultsWe identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22–6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029).ConclusionCandidainfection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.