Motz Kevin, Herbert Robert J, Fakhry Carole, Quon Harry, Kang Hyunseok, Kiess Ana P, Eisele David W, Koch Wayne M, Frick Kevin D, Gourin Christine G
Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, U.S.A.
Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
Laryngoscope. 2018 Sep;128(9):2084-2093. doi: 10.1002/lary.27153. Epub 2018 Mar 24.
To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients (age > 65 years) treated for oropharyngeal squamous cell cancer (SCCA).
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data.
Longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis.
Dysphagia (odds ratio [OR] = 1.3, 1.0-1.7), esophageal stricture (OR = 5.5, 2.6-11.9), and airway obstruction (OR = 1.6, 1.1-2.2) 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 = 3.0, 1.4-6.4), pneumonia (OR = 4.5, 1.8-11.2), and stricture (OR = 5.5, 1.8-17.6). Pretreatment dysphagia was a significant predictor of long-term dysphagia, airway obstruction, and pneumonia. Chemoradiation, advanced stage disease, high-volume hospital care, male sex, and salvage surgery were significant predictors of long-term gastrostomy use. Long-term dysphagia, gastrostomy or tracheostomy dependence, weight loss, airway obstruction, and pneumonia were associated with poorer survival, with tracheostomy dependence (hazard ratio [HR] = 2.2, 1.7-2.9) and pneumonia (HR = 2.0, 1.7-2.4) associated with the greatest risk of late mortality.
Airway and swallowing impairment is common after treatment of oropharyngeal SCCA in elderly patients, increases over time, and is associated with poorer survival. Patients with pretreatment dysphagia, advanced stage disease, initial treatment with chemoradiation, and salvage surgery represent a high-risk group with an increased risk of disability and death.
2c. Laryngoscope, 128:2084-2093, 2018.
研究老年（年龄>65岁）口咽鳞状细胞癌（SCCA）患者治疗前变量、短期和长期吞咽及气道功能损害与生存之间的关联。
对监测、流行病学与最终结果（SEER）-医疗保险数据进行回顾性分析。
使用交叉表、多变量逻辑回归和生存分析对2004年至2007年确诊为口咽SCCA的666例患者的纵向数据进行评估。
吞咽困难（优势比[OR]=1.3，1.0 - 1.7）、食管狭窄（OR = 5.5，2.6 - 11.9）和气道阻塞（OR = 1.6，1.1 - 2.2）在治疗后1年增加。随后几年气道阻塞、食管狭窄和肺炎的几率增加，5年时气道阻塞（OR = 3.0，1.4 - 6.4）、肺炎（OR = 4.5，1.8 - 11.2）和狭窄（OR = 5.5，1.8 - 17.6）的风险显著增加。治疗前吞咽困难是长期吞咽困难、气道阻塞和肺炎的重要预测因素。放化疗、晚期疾病、大量医院护理、男性性别和挽救性手术是长期使用胃造口术的重要预测因素。长期吞咽困难、胃造口术或气管造口术依赖、体重减轻、气道阻塞和肺炎与较差的生存率相关，气管造口术依赖（风险比[HR]=2.2，1.7 - 2.9）和肺炎（HR = 2.0，1.7 - 2.4）与晚期死亡风险最高相关。
老年患者口咽SCCA治疗后气道和吞咽功能损害常见，且随时间增加，并与较差的生存率相关。治疗前有吞咽困难、晚期疾病、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。
2c。《喉镜》，128:2084 - 2093，2018年。
