Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades
Grading Dysphagia as a Toxicity of Head and Neck Cancer: Differences in Severity Classification Based on MBS DIGEST and Clinical CTCAE Grades
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DOI：
10.1007/s00455-017-9843-x
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发表时间：
2018-04-01
期刊：
影响因子：
2.6
通讯作者：
Hutcheson, Katherine A.
中科院分区：
文献类型：
--
作者：
Goepfert, Ryan P.;Lewin, Jan S.;Hutcheson, Katherine A.
根据不良事件的通用术语标准（CTCAE），吞咽困难的分期，根据症状、饮食和管道依赖，由临床医生报告毒性分级。新的吞咽毒性动态成像分级（DIGEST）工具提供了一个类似的5点有序咽部吞咽综合分级，这是通过改良吞钡（MBS）研究的结果确定的。本研究旨在告知临床医生，根据临床CTCAE和mbs衍生的DIGEST分级，吞咽困难严重程度之间的异同。从前瞻性获得的接受器官保存策略治疗的头颈癌患者的MBS数据库中随机选择95个MBS研究的横断面样本。比较MBS DIGEST和临床CTCAE吞咽困难分级。DIGEST和CTCAE吞咽困难分级的加权kappa“公平”一致性为0.358 （95% CI 0.231 - 0.485）。以DIGEST >= 3为参照阈值，CTCAE鉴别重度吞咽困难的总敏感性为0.50，特异性为0.84，曲线下面积（AUC）为0.67。在小于6个月时，CTCAE检测吞咽困难的灵敏度为0.72，特异性为0.76，AUC为0.75；在大于6个月时，CTCAE检测吞咽困难的灵敏度为0.22，特异性为0.90，AUC为0.56。根据临床衍生的CTCAE，使用DIGEST在MBS上对咽部吞咽困难进行分类，增强了我们对吞咽困难严重程度的理解，同时保持了有序量表的简洁性。DIGEST可能通过提高急性期生理性吞咽困难的特异性和提高晚期吞咽困难的敏感性来补充CTCAE毒性分级。
Clinician-reported toxicity grading through common terminology criteria for adverse events (CTCAE) stages dysphagia based on symptoms, diet, and tube dependence. The new dynamic imaging grade of swallowing toxicity (DIGEST) tool offers a similarly scaled five-point ordinal summary grade of pharyngeal swallowing as determined through results of a modified barium swallow (MBS) study. This study aims to inform clinicians on the similarities and differences between dysphagia severity according to clinical CTCAE and MBS-derived DIGEST grading. A cross-sectional sample of 95 MBS studies was randomly selected from a prospectively-acquired MBS database among patients treated with organ preservation strategies for head and neck cancer. MBS DIGEST and clinical CTCAE dysphagia grades were compared. DIGEST and CTCAE dysphagia grades had "fair" agreement per weighted kappa of 0.358 (95% CI .231-.485). Using a threshold of DIGEST >= 3 as reference, CTCAE had an overall sensitivity of 0.50, specificity of 0.84, and area under the curve (AUC) of 0.67 to identify severe MBS-detected dysphagia. At less than 6 months, sensitivity was 0.72, specificity was 0.76, and AUC was 0.75 while at greater than 6 months, sensitivity was 0.22, specificity was 0.90, and AUC was 0.56 for CTCAE to detect dysphagia as determined by DIGEST. Classification of pharyngeal dysphagia on MBS using DIGEST augments our understanding of dysphagia severity according to the clinically-derived CTCAE while maintaining the simplicity of an ordinal scale. DIGEST likely complements CTCAE toxicity grading through improved specificity for physiologic dysphagia in the acute phase and improved sensitivity for dysphagia in the late-phase.