Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study.
Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study.
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局部晚期头颈癌根治性放化疗或生物放疗后发生吸入性肺炎的危险因素：单中心病例对照研究。
DOI：
10.1186/s12885-017-3052-8
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发表时间：
2017-01-17
期刊：
影响因子：
3.8
通讯作者：
Yasui H
中科院分区：
文献类型：
--
作者：
Kawai S;Yokota T;Onozawa Y;Hamauchi S;Fukutomi A;Ogawa H;Onoe T;Onitsuka T;Yurikusa T;Todaka A;Tsushima T;Yoshida Y;Kito Y;Mori K;Yasui H
放化疗（CRT）和生物放疗（BRT）被认为是头颈癌（HNC）的标准治疗方法。CRT或BRT后吸入性肺炎是常见的晚期不良事件。我们在这项研究中的目的是评估CRT或BRT后吸入性肺炎的病因特异性发生率，并确定其临床危险因素。我们对2006年8月至2015年4月间接受CRT或BRT治疗的305例局部晚期HNC患者进行了回顾性分析。在这305例患者中，65例（21.3%）在治疗后发生吸入性肺炎。中位发病时间为治疗后161天。通过CRT或BRT进行的两年病因特异性累积发病率为21.0%。多因素分析显示吸入性肺炎的5个独立危险因素为：习惯性饮酒、治疗结束时服用安眠药、口腔卫生不良、治疗前低白蛋白血症和其他恶性肿瘤共存。利用这些危险因素和治疗效果构建预测模型，将患者分为低（0-2个预测因素）、中（3-4个因素）和高危（5-6个因素）组，两年内吸入性肺炎的累计发病率分别为3.0、41.6和77.3%。吸入性肺炎往往与死亡风险增加相关，尽管这没有统计学意义（多变量校正风险比1.39,P = 0.18）。研究了局部晚期HNC患者确诊CRT或BRT后吸入性肺炎的病因特异性发病率和临床危险因素。我们的预测模型可能有助于识别吸入性肺炎的高危患者。
Chemoradiotherapy (CRT) and bio-radiotherapy (BRT) are recognized as standard therapies for head and neck cancer (HNC). Aspiration pneumonia after CRT or BRT is a common late adverse event. Our aim in this study was to evaluate the cause-specific incidence of aspiration pneumonia after CRT or BRT and to identify its clinical risk factors. We performed a retrospective analysis of 305 patients with locally advanced HNC treated by CRT or BRT between August 2006 and April 2015. Of these 305 patients, 65 (21.3%) developed aspiration pneumonia after treatment. The median onset was 161 days after treatment. The two-year cause-specific cumulative incidence by CRT or BRT was 21.0%. Multivariate analysis revealed five independent risk factors for aspiration pneumonia, namely, habitual alcoholic consumption, use of sleeping pills at the end of treatment, poor oral hygiene, hypoalbuminemia before treatment, and the coexistence of other malignancies. A predictive model using these risk factors and treatment efficacy was constructed, dividing patients into low- (0–2 predictive factors), moderate- (3–4 factors), and high-risk groups (5–6 factors), the two-year cumulative incidences of aspiration pneumonia of which were 3.0, 41.6, and 77.3%, respectively. Aspiration pneumonia tended to be associated with increased risk of death, although this was not statistically significant (multivariate-adjusted hazard ratio 1.39, P = 0.18). The cause-specific incidence and clinical risk factors for aspiration pneumonia after definitive CRT or BRT were investigated in patients with locally advanced HNC. Our predictive model may be useful for identifying patients at high risk for aspiration pneumonia.