Gourin Christine G, Starmer Heather M, Herbert Robert J, Frick Kevin D, Forastiere Arlene A, Eisele David W, Quon Harry
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
Laryngoscope. 2015 Apr;125(4):924-33. doi: 10.1002/lary.25012. Epub 2014 Nov 4.
OBJECTIVES/HYPOTHESIS: To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for laryngeal squamous cell cancer (SCCA).
Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data.
Longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis.
Dysphagia (odds ratio [OR] = 1.5 [1.2-1.7]), weight loss (OR = 1.3 [1.1-1.6]), esophageal stricture (OR = 3.8 [2.5-5.9]), airway obstruction (OR = 1.9, [1.6-2.3]), tracheostomy (OR = 1.5 [1.2-1.9]), and pneumonia (OR = 1.8 [1.4-2.2]) increased 1 year after treatment. The odds of airway obstruction, esophageal stricture, and pneumonia increased over subsequent years, with significantly increased risk at 5 years for airway obstruction (OR = 3.3 [1.8-5.8]) and pneumonia (OR = 5.2 [2.5-10.7]). Pretreatment dysphagia, chemoradiation, and salvage surgery were significant predictors of long-term dysphagia, weight loss, tracheostomy, and gastrostomy, with pretreatment dysphagia and salvage surgery also associated with pneumonia. Surgery and postoperative radiation was associated with long-term dysphagia (OR = 1.4 [1.0-1.9]) but reduced odds of long-term pneumonia (OR = 0.7 [0.5-0.9]). Long-term dysphagia, gastrostomy or tracheostomy dependence, weight loss, airway obstruction, and pneumonia were associated with poorer survival, with pneumonia associated with the greatest risk of death at 5 years (hazard ratio = 2.6 [2.4-2.9]).
Airway and swallowing impairment is common after laryngeal SCCA treatment in elderly patients, increases over time, and is associated with poorer survival-with pneumonia associated with the highest risk of long-term mortality. Patients with pretreatment dysphagia, initial treatment with chemoradiation, and salvage surgery represent a high-risk group with an increased risk of disability and death.
目的/假设：研究老年喉鳞状细胞癌（SCCA）患者治疗前变量、短期和长期吞咽及气道损伤与生存之间的关联。
对监测、流行病学和最终结果-医疗保险数据进行回顾性分析。
使用交叉表、多因素逻辑回归和生存分析对2004年至2007年诊断为喉SCCA的2370例患者的纵向数据进行评估。
吞咽困难（比值比[OR]=1.5[1.2-1.7]）、体重减轻（OR=1.3[1.1-1.6]）、食管狭窄（OR=3.8[2.5-5.9]）、气道阻塞（OR=1.9，[1.6-2.3]）、气管切开术（OR=1.5[1.2-1.9]）和肺炎（OR=1.8[1.4-2.2]）在治疗后1年增加。气道阻塞、食管狭窄和肺炎的几率在随后几年增加，气道阻塞在5年时风险显著增加（OR=3.3[1.8-5.8]），肺炎（OR=5.2[2.5-10.7]）。治疗前吞咽困难、放化疗和挽救性手术是长期吞咽困难、体重减轻、气管切开术和胃造口术的重要预测因素，治疗前吞咽困难和挽救性手术也与肺炎有关。手术和术后放疗与长期吞咽困难有关（OR=1.4[1.0-1.9]），但长期肺炎几率降低（OR=0.7[0.5-0.9]）。长期吞咽困难、胃造口术或气管切开术依赖、体重减轻、气道阻塞和肺炎与较差的生存率相关，肺炎在5年时死亡风险最高（风险比=2.6[2.4-2.9]）。
老年患者喉SCCA治疗后气道和吞咽损伤常见，随时间增加，且与较差的生存率相关，肺炎长期死亡风险最高。治疗前有吞咽困难、初始接受放化疗和挽救性手术的患者是残疾和死亡风险增加的高危人群。
