Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
Oral Oncol. 2018 Apr;79:33-39. doi: 10.1016/j.oraloncology.2018.02.012. Epub 2018 Feb 22.
It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status.
Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%.
HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL.
The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.
众所周知，口咽癌患者存在较高的营养风险，体重明显下降且常需进行管饲。人乳头瘤病毒（HPV）相关疾病导致该人群的“典型”表现和营养状况发生了变化。本研究旨在确定 HPV 状态对口咽癌患者放疗期间是否需要进行管饲以及体重减轻的影响。
纳入 2011 年 1 月至 2016 年 1 月接受根治性放化疗的患者（n=100）。我们回顾性评估了管饲的使用情况以及置管时间（预防性 vs 反应性）、放疗期间体重减轻的百分比以及临界体重减轻（CWL）≥5%的发生率。
HPV 阳性患者在放疗期间的体重减轻明显高于其余患者（8.4% vs 6.1%，95%CI 0.8-3.9，p=0.003）。CWL 发生率为 86%，HPV 阳性疾病患者的发生率更高（93%，p=0.011）。条件概率模型分析显示，在比较 HPV 阳性患者和 HPV 阴性患者时，同期放化疗和 HPV 阳性状态的准确率为 74%，可预测 CWL（HPV 阳性患者分别为 96%，p=0.001 和 98%，p=0.012）。更多 HPV 阳性患者需要进行管饲（n=43，63%，p=0.05），其中大多数为反应性管饲（n=27，63%）。所有接受反应性管饲的患者均发生 CWL。
HPV 阳性口咽癌患者 CWL 的发生率较高，令人担忧。管饲仍然是该人群的必要营养干预措施，预测哪些患者需要管饲具有挑战性。需要更大规模的前瞻性队列研究。
