Xu Beibei, Boero Isabel J, Hwang Lindsay, Le Quynh-Thu, Moiseenko Vitali, Sanghvi Parag R, Cohen Ezra E W, Mell Loren K, Murphy James D
Medical Informatics Center, Peking University, Beijing, China.
Cancer. 2015 Apr 15;121(8):1303-11. doi: 10.1002/cncr.29207. Epub 2014 Dec 23.
Aspiration pneumonia represents an under-reported complication of chemoradiotherapy in patient with head and neck cancer. The objective of the current study was to evaluate the incidence, risk factors, and mortality of aspiration pneumonia in a large cohort of patients with head and neck cancer who received concurrent chemoradiotherapy.
Patients who had head and neck cancer diagnosed between 2000 and 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Aspiration pneumonia was identified from Medicare billing claims. The cumulative incidence, risk factors, and survival after aspiration pneumonia were estimated and compared with a noncancer population.
Of 3513 patients with head and neck cancer, 801 developed aspiration pneumonia at a median of 5 months after initiating treatment. The 1-year and 5-year cumulative incidence of aspiration pneumonia was 15.8% and 23.8%, respectively, for patients with head and neck cancer and 3.6% and 8.7%, respectively, for noncancer controls. Among the patients with cancer, multivariate analysis identified independent risk factors (P < .05) for aspiration pneumonia, including hypopharyngeal and nasopharyngeal tumors, male gender, older age, increased comorbidity, no surgery before radiation, and care received at a teaching hospital. Among the patients with cancer who experienced aspiration pneumonia, 674 (84%) were hospitalized; and, of these, 301 (45%) were admitted to an intensive care unit. The 30-day mortality rate after hospitalization for aspiration pneumonia was 32.5%. Aspiration pneumonia was associated with a 42% increased risk of death (hazard ratio, 1.42; P < .001) after controlling for confounders.
The current results indicated that nearly 25% of elderly patients will develop aspiration pneumonia within 5 years after receiving chemoradiotherapy for head and neck cancer. A better understanding of mitigating factors will help identify patients who are at risk for this potentially lethal complication.
吸入性肺炎是头颈癌患者放化疗后一种报告不足的并发症。本研究的目的是评估接受同步放化疗的大批头颈癌患者中吸入性肺炎的发病率、危险因素及死亡率。
从监测、流行病学及最终结果-医疗保险数据库中识别出2000年至2009年间诊断为头颈癌的患者。通过医疗保险计费索赔识别出吸入性肺炎。估计吸入性肺炎的累积发病率、危险因素及发病后的生存率，并与非癌症人群进行比较。
在3513名头颈癌患者中，801例在开始治疗后中位时间5个月时发生吸入性肺炎。头颈癌患者吸入性肺炎的1年和5年累积发病率分别为15.8%和23.8%，非癌症对照分别为3.6%和8.7%。在癌症患者中，多变量分析确定了吸入性肺炎的独立危险因素（P<0.05），包括下咽和鼻咽癌、男性、年龄较大、合并症增加、放疗前未手术以及在教学医院接受治疗。在发生吸入性肺炎的癌症患者中，674例（84%）住院；其中，301例（45%）入住重症监护病房。吸入性肺炎住院后30天死亡率为32.5%。在控制混杂因素后，吸入性肺炎与死亡风险增加42%相关（风险比，1.42；P<0.001）。
目前结果表明，近25%的老年患者在接受头颈癌放化疗后5年内会发生吸入性肺炎。更好地了解缓解因素将有助于识别有这种潜在致命并发症风险的患者。
