Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Oral Oncol. 2011 Sep;47(9):910-4. doi: 10.1016/j.oraloncology.2011.06.510. Epub 2011 Jul 28.
Basic patient and tumor characteristics impact overall survival of head and neck squamous cell carcinoma patients. Severe malnutrition, defined as weight loss > 10% in 6 months preceding primary tumor diagnosis, impacts overall survival as well. Little attention has been paid to the interaction between severe malnutrition and other relevant prognostic covariables. This study investigates the impact of malnutrition on short-term mortality and overall survival, together with the covariables age, tumor site, gender, TNM-classification, comorbidity and prior tumors.
383 consecutive primary HNSCC patients, diagnosed and treated between 1995 and 1999 were followed until January 2010. Impact of covariables on short-term mortality and overall survival was studied univariately with Kaplan-Meier curves and the log-rank test. Cox-regression and binary logistic regression were used for multivariate analyses.
28 (7.3%) patients were severely malnourished. All covariables, except gender and prior tumors had significant impact on overall survival. The relative risk of severe malnutrition was 1.8 and is comparable to the impact of a T2 tumor, a N1 neck or moderate comorbidity. A univariate relationship between severe malnutrition and short-term mortality was established.
Severe malnutrition has an independent impact on overall survival of primary HNSCC patients. There is a clear distinction between patients with and without severe malnutrition from moment of diagnosis until 10 years after. This emphasizes the importance of identification and optimal treatment of malnutrition before, during and after cancer treatment.
基本的患者和肿瘤特征会影响头颈部鳞状细胞癌患者的总生存率。在原发性肿瘤诊断前 6 个月体重下降>10%的严重营养不良也会影响总生存率。很少关注严重营养不良与其他相关预后协变量之间的相互作用。本研究调查了营养不良对短期死亡率和总生存率的影响，同时还研究了年龄、肿瘤部位、性别、TNM 分类、合并症和先前肿瘤等协变量。
对 1995 年至 1999 年间诊断和治疗的 383 例连续原发性 HNSCC 患者进行随访，直到 2010 年 1 月。使用 Kaplan-Meier 曲线和对数秩检验对协变量对短期死亡率和总生存率的影响进行单变量分析。使用 Cox 回归和二元逻辑回归进行多变量分析。
28 例（7.3%）患者存在严重营养不良。除性别和先前肿瘤外，所有协变量均对总生存率有显著影响。严重营养不良的相对风险为 1.8，与 T2 肿瘤、N1 颈部或中度合并症的影响相当。在单变量分析中，建立了严重营养不良与短期死亡率之间的关系。
严重营养不良对头颈部鳞状细胞癌患者的总生存率有独立影响。从诊断时到 10 年后，严重营养不良患者和无严重营养不良患者之间存在明显差异。这强调了在癌症治疗前、治疗期间和治疗后识别和优化营养不良治疗的重要性。
