Qiu Wen-Ze, Ke Liang-Ru, Xia Wei-Xiong, Yang Jing, Yu Ya-Hui, Liang Hu, Huang Xin-Jun, Liu Guo-Ying, Li Wang-Zhong, Xiang Yan-Qun, Guo Xiang, Lv Xing
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.
Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
PLoS One. 2017 Aug 10;12(8):e0182963. doi: 10.1371/journal.pone.0182963. eCollection 2017.
To evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy.
The current study was conducted with NPC patients undergoing radiotherapy at Sun Yat-Sen University Cancer Center between June 2011 and May 2012. A clinical diagnosis of candidiasis was determined on the basis of a positive potassium hydroxide (KOH) test and the presence of pseudomembranous (white) form of candidal overgrowth. The Cox proportional hazard regression model was used to test the association of OPC and related survival rates.
Compared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3-4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P<0.001) during radiotherapy. The OPC group had a significantly lower disease-free survival (DFS) (70.9% vs. 82.6%, P = 0.012), mainly as a result of a reduction in locoregional relapse-free survival (LRFS) (87.0%vs. 94.9%, P = 0.025). After stratification by T stage, the 5-year DFS in T3-4 patients were 82.0% and 68.8% in non-OPC and OPC groups, respectively (P = 0.022). Multivariate analyses indicated that OPC was a prognostic factor for LRFS and DFS.
OPC during radiotherapy may worsen the nutritional status of NPC patients according to weight loss and anaemia, leading to a negative impact on 5-year locoregional relapse-free survival and disease-specific survival. Further investigations are needed to explore whether prevention and treatment of OPC during radiotherapy will be useful.
评估接受放射治疗的鼻咽癌（NPC）患者伴或不伴口咽念珠菌病（OPC）的临床特征、治疗相关毒性及生存情况。
本研究纳入了2011年6月至2012年5月在中山大学肿瘤防治中心接受放射治疗的NPC患者。基于氢氧化钾（KOH）试验阳性及假膜（白色）形式的念珠菌过度生长来确定念珠菌病的临床诊断。采用Cox比例风险回归模型来检验OPC与相关生存率的关联。
与非OPC组相比，OPC组在放射治疗期间3 - 4级黏膜炎（14.5%对7.4%，P = 0.049）、贫血（11.3%对4.4%，P = 0.020）、肝毒性（4.8%对1.1%，P = 0.021）及严重体重减轻（85.5%对56.6%，P<0.001）的发生率显著增加。OPC组的无病生存期（DFS）显著更低（70.9%对82.6%，P = 0.012），主要是由于局部区域无复发生存期（LRFS）降低（87.0%对94.9%，P = 0.025）。按T分期分层后，T3 - 4期患者非OPC组和OPC组的5年DFS分别为82.0%和68.8%（P = 0.022）。多因素分析表明OPC是LRFS和DFS的预后因素。
放射治疗期间的OPC可能根据体重减轻和贫血情况恶化NPC患者的营养状况，对5年局部区域无复发生存期和疾病特异性生存期产生负面影响。需要进一步研究以探索放射治疗期间预防和治疗OPC是否有用。
