Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.
Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 1;144(11):1066-1076. doi: 10.1001/jamaoto.2018.1791.
Lower cranial neuropathy (LCNP) is a rare but potentially disabling result of radiotherapy and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment, with deficits in swallowing, speech, and voice.
To investigate the association of late LCNP with severity of cancer treatment-related symptoms and subsequent general functional impairment among oropharyngeal cancer (OPC) survivors.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study analyzed 889 OPC survivors nested within a retrospective cohort of OPC survivors treated at MD Anderson Cancer Center from January 1, 2000, to December 31, 2013. Eligible survey participants were disease free and completed OPC treatment 1 year or more before the survey. Data analysis was performed from October 10, 2017, to March 15, 2018.
Late LCNP defined by onset 3 months or more after cancer therapy.
The primary outcome variable was the mean of the top 5 most severely scored symptoms of all 22 core and head and neck cancer-specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN). Secondary outcomes included mean MDASI-HN interference scores and single-item scores of the most severe symptoms. Multivariate models regressed MDASI-HN scores on late LCNP status, adjusting for clinical covariates.
Overall, 36 of 889 OPC survivors (4.0%) (753 [84.7%] male; 821 [92.4%] white; median [range] age, 56 [32-84] years; median [range] survival time, 7 [1-16] years) developed late LCNP. Late LCNP was significantly associated with worse mean top 5 MDASI-HN symptom scores (coefficient, 1.54; 95% CI, 0.82-2.26), adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, type of radiotherapy, smoking, and normal diet before treatment. Late LCNP was also significantly associated with single-item scores for difficulty swallowing or chewing (coefficient, 2.25; 95% CI, 1.33-3.18), mucus (coefficient, 1.97; 95% CI, 1.03-2.91), fatigue (coefficient, 1.35; 95% CI, 0.40-2.21), choking (coefficient, 1.53; 95% CI, 0.65-2.41), and voice or speech symptoms (coefficient, 2.30; 95% CI, 1.60-3.03) in multivariable models. Late LCNP was not significantly associated with mean interference scores after correction for multiple comparisons (mean interference coefficient, 0.72; 95% CI, 0.09-1.35).
In this large survey study, OPC survivors with late LCNP reported worse cancer treatment-related symptoms, a finding suggesting an association between late LCNP and symptom burden. This research may inform the development and implementation of strategies for LCNP surveillance and management.
颅神经病变（LCNP）是放疗和其他头颈部癌症治疗的罕见但潜在致残结果。发生晚期 LCNP 的幸存者可能会经历严重的功能障碍，出现吞咽、言语和声音方面的缺陷。
调查晚期 LCNP 与口咽癌（OPC）幸存者癌症治疗相关症状严重程度和随后一般功能障碍之间的关联。
设计、地点和参与者：这项横断面调查研究分析了嵌套在 MD Anderson 癌症中心 2000 年 1 月 1 日至 2013 年 12 月 31 日期间接受治疗的 OPC 幸存者的回顾性队列中的 889 名 OPC 幸存者。有资格参加调查的患者在调查前 1 年或以上疾病无进展且已完成 OPC 治疗。数据分析于 2017 年 10 月 10 日至 2018 年 3 月 15 日进行。
癌症治疗后 3 个月或更长时间出现的晚期 LCNP。
主要结局变量是 MD Anderson 症状量表头颈部癌症模块（MDASI-HN）的 22 个核心症状和头颈部癌症特异性症状中前 5 个最严重症状的平均分。次要结局包括 MDASI-HN 干扰评分的平均值和最严重症状的单项评分。多变量模型根据晚期 LCNP 状态调整了 MDASI-HN 评分，调整了临床协变量。
共有 889 名 OPC 幸存者中的 36 名（4.0%）（753 [84.7%]男性；821 [92.4%]白人；中位数[范围]年龄，56 [32-84]岁；中位数[范围]生存时间，7 [1-16]年）发生了晚期 LCNP。晚期 LCNP 与更严重的平均前 5 个 MDASI-HN 症状评分显著相关（系数，1.54；95%CI，0.82-2.26），调整了年龄、生存时间、性别、治疗方式、T 分期、部位、放疗类型、吸烟和治疗前正常饮食。晚期 LCNP 还与吞咽或咀嚼困难（系数，2.25；95%CI，1.33-3.18）、黏液（系数，1.97；95%CI，1.03-2.91）、疲劳（系数，1.35；95%CI，0.40-2.21）、窒息（系数，1.53；95%CI，0.65-2.41）和声音或言语症状（系数，2.30；95%CI，1.60-3.03）的单一项评分显著相关。经多变量校正后，晚期 LCNP 与平均干扰评分无显著相关性（平均干扰系数，0.72；95%CI，0.09-1.35）。
在这项大型调查研究中，发生晚期 LCNP 的 OPC 幸存者报告了更严重的癌症治疗相关症状，这表明晚期 LCNP 与症状负担之间存在关联。这项研究可以为晚期 LCNP 的监测和管理策略的制定和实施提供信息。
