Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: supplementary analysis of a phase II trial (JCOG0706S1)
Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: supplementary analysis of a phase II trial (JCOG0706S1)
复制标题
头颈癌根治性放化疗后的营养支持依赖性：II 期试验的补充分析 (JCOG0706S1)
DOI：
10.1093/jjco/hyz121
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发表时间：
2019
影响因子：
2.4
通讯作者：
Japan Clinical Oncology Group (JCOG) Head and Neck C
中科院分区：
文献类型：
--
作者：
Imamura Yoshinori;Kiyota Naomi;Ogawa Gakuto;Akimoto Tetsuo;Fujii Masato;Hanai Nobuhiro;Iwae Shigemichi;Monden Nobuya;Matsuura Kazuto;Onozawa Yusuke;Hayashi Ryuichi;Tahara Makoto;Minami Shujiro;Eba Junko;Japan Clinical Oncology Group (JCOG) Head and Neck C
目的在JCOG0706 （UMIN000001272）的II期临床试验中，探讨不可切除局部晚期头颈部癌患者接受放化疗后12个月喉-食管功能障碍无生存和营养支持依赖的危险因素。方法45例患者接受放射治疗，总剂量为70 Gy/35fr，同时接受S-1和顺铂治疗。结合放化疗前患者实验室数据，分别采用Cox回归模型和logistic回归模型分析12个月喉-食管无功能障碍生存和营养支持依赖的危险因素。对辐射场进行综述，分析辐射场大小与功能预后的关系。结果中位随访期为3.5年，3年无喉-食管功能障碍生存率为48.9%。对于喉-食管无功能障碍生存率，登记时接受营养支持的患者的风险比为2.35（与未接受营养支持的患者相比；95%可信区间为0.96-5.76）。对于超过12个月的营养支持依赖，血红蛋白低于中位数13.4 g/dl的患者的比值比为6.77（高于或等于中位数，95%可信区间为1.24-36.85），白蛋白低于中位数3.9 g/dl的患者的比值比为6.00（高于或等于中位数，95%可信区间为1.11-32.54）。营养支持依赖超过12个月的无病患者的主要部位为口咽（N= 2）或下咽（N= 1），所有咽收缩肌都包括在治疗剂量的照射场中。结论：本补充分析显示，需要营养支持的严重吞咽困难、贫血和低白蛋白血症的预处理可能对头颈癌放化疗后的长期功能预后产生负面影响。
ObjectivesTo explore the risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months in patients with unresectable locally advanced head and neck carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706 (UMIN000001272).MethodsForty-five patients received radiation therapy for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. Risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months were analyzed using Cox regression models and logistic regression models, respectively, with consideration to patient laboratory data just before chemoradiotherapy. Radiation fields were reviewed to analyze the relationship between the extent of the irradiated field and functional outcome.ResultsWith a median follow-up period of 3.5 years, 3-year laryngo-esophageal dysfunction-free survival was 48.9%. For laryngo-esophageal dysfunction-free survival, hazards ratio of 2.35 in patients with nutritional support at registration (vs. without nutritional support; 95% confidence interval 0.96–5.76). For nutritional support dependence over 12 months, odds ratio was 6.77 in patients with hemoglobin less than the median of 13.4 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.24–36.85) and was 6.00 in patients with albumin less than the median of 3.9 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.11–32.54). Primary sites in disease-free patients with nutritional support dependence over 12 months were the oropharynx (N= 2) or hypopharynx (N= 1), and all pharyngeal constrictor muscles were included in irradiated fields with a curative dose.ConclusionsThis supplementary analysis showed that pretreatment severe dysphagia requiring nutritional support, anemia and hypoalbuminemia might have a negative prognostic impact on long-term functional outcomes after curative chemoradiotherapy in head and neck cancer.