Adelaide Medical School, University of Adelaide, Helen Mayo Building (Adelaide Medical School) Frome Road, Adelaide, South Australia, 5005, Australia.
Department of Pediatric Oncology/Hematology, The University of Groningen, University Medical Centre Groningen (Beatrix Children's Hospital), Groningen, The Netherlands.
Support Care Cancer. 2020 Nov;28(11):5059-5073. doi: 10.1007/s00520-020-05579-7. Epub 2020 Jun 26.
Despite advances in personalizing the efficacy of cancer therapy, our ability to identify patients at risk of severe treatment side effects and provide individualized supportive care is limited. This is particularly the case for mucositis (oral and gastrointestinal), with no comprehensive risk evaluation strategies to identify high-risk patients. We, the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) Mucositis Study Group, therefore aimed to systematically review current evidence on that factors that influence mucositis risk to provide a foundation upon which future risk prediction studies can be based.
We identified 11,018 papers from PubMed and Web of Science, with 197 records extracted for full review and 113 meeting final eligibility criteria. Data were then synthesized into tables to highlight the level of evidence for each risk predictor.
The strongest level of evidence supported dosimetric parameters as key predictors of mucositis risk. Genetic variants in drug-metabolizing pathways, immune signaling, and cell injury/repair mechanisms were also identified to impact mucositis risk. Factors relating to the individual were variably linked to mucositis outcomes, although female sex and smoking status showed some association with mucositis risk.
Mucositis risk reflects the complex interplay between the host, tumor microenvironment, and treatment specifications, yet the large majority of studies rely on hypothesis-driven, single-candidate approaches. For significant advances in the provision of personalized supportive care, coordinated research efforts with robust multiplexed approaches are strongly advised.
尽管在个性化癌症治疗效果方面取得了进展，但我们识别有严重治疗副作用风险的患者并提供个体化支持性护理的能力有限。这在口腔黏膜炎（口腔和胃肠道）尤其如此，目前尚无全面的风险评估策略来识别高风险患者。因此，我们多国癌症支持治疗协会/国际口腔肿瘤学会（MASCC/ISOO）口腔黏膜炎研究组旨在系统回顾影响口腔黏膜炎风险的现有证据，为未来的风险预测研究提供基础。
我们从 PubMed 和 Web of Science 中确定了 11018 篇论文，提取了 197 篇记录进行全面审查，有 113 篇符合最终入选标准。然后将数据综合制成表格，突出每个风险预测因素的证据水平。
证据最强的是剂量学参数作为口腔黏膜炎风险的关键预测因素。药物代谢途径、免疫信号和细胞损伤/修复机制中的遗传变异也被确定为影响口腔黏膜炎风险的因素。与个体相关的因素与口腔黏膜炎结局之间存在不同程度的关联，尽管女性性别和吸烟状况与口腔黏膜炎风险有一定关联。
口腔黏膜炎风险反映了宿主、肿瘤微环境和治疗规范之间的复杂相互作用，但绝大多数研究依赖于假设驱动的单一候选方法。为了在提供个性化支持性护理方面取得重大进展，强烈建议开展协调一致的、具有强大多重分析方法的研究。
