Clinical Epidemiology Unit, Laval University Cancer Research Center, CHUQ-Hôtel Dieu de Québec, Quebec City, Quebec, Canada.
Cancer. 2010 May 1;116(9):2275-83. doi: 10.1002/cncr.25041.
The purpose of the study was to identify predictors of weight loss during radiotherapy (RT) in patients with stage I or II head and neck (HN) cancer.
This study was conducted as part of a phase 3 chemoprevention trial. A total of 540 patients were randomized. The patients were weighed before and after RT. Their baseline characteristics, including lifestyle habits, diet, and quality of life, were assessed as potential predictors. Predictors were identified using multiple linear regressions. The reliability of the model was assessed by bootstrap resampling. A receiver operating characteristics curve was generated to estimate the model's accuracy in predicting critical weight loss (>or=5%).
The mean weight loss was 2.2 kg (standard deviation, 3.4). Five factors were associated with a greater weight loss: all HN cancer sites other than the glottic larynx (P<.001), higher pre-RT body weight (P<.001), stage II disease (P = .002), dysphagia and/or odynophagia before RT (P = .001), and a lower Karnofsky performance score (P = .028). There was no association with pre-RT lifestyle habits, diet, or quality of life. The bootstrapping method confirmed the reliability of this predictive model. The area under the curve was 71.3% (95% confidence interval, 65.8-76.9), which represents an acceptable ability of the model to predict critical weight loss.
These results could be useful to clinicians for screening patients with early stage HN cancer treated by RT who require special nutritional attention.
本研究旨在确定 I 期或 II 期头颈部 (HN) 癌症患者接受放疗 (RT) 期间体重减轻的预测因素。
本研究作为 III 期化学预防试验的一部分进行。共纳入 540 例患者进行随机分组。患者在 RT 前后称重。评估其基线特征，包括生活方式习惯、饮食和生活质量，以确定潜在的预测因素。采用多元线性回归识别预测因素。通过自举重采样评估模型的可靠性。生成受试者工作特征曲线以估计模型预测临界体重减轻（≥5%）的准确性。
平均体重减轻 2.2kg（标准差，3.4）。5 个因素与体重减轻较大相关：除声门型喉癌以外的所有 HN 癌部位（P<.001）、较高的 RT 前体重（P<.001）、II 期疾病（P =.002）、RT 前吞咽困难和/或疼痛（P =.001）以及 Karnofsky 表现评分较低（P =.028）。与 RT 前的生活方式习惯、饮食或生活质量无相关性。自举法证实了该预测模型的可靠性。曲线下面积为 71.3%（95%置信区间，65.8-76.9），表明该模型预测临界体重减轻的能力尚可。
这些结果可能有助于临床医生筛选接受 RT 治疗的早期 HN 癌症患者，以便为其提供特殊的营养关注。
