Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, AIMS Ponekkara PO, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Dysphagia. 2021 Dec;36(6):974-983. doi: 10.1007/s00455-020-10224-w. Epub 2021 Jan 2.
This study aimed to characterize the swallowing outcomes after glossectomy and analyze factors affecting them. An attempt is made to propose a classification system and corroborate it to the results. This is a cross-sectional study to assess swallowing in carcinoma tongue patients treated surgically with or without reconstruction, followed by adjuvant therapy as indicated. One hundred and six patients were evaluated with videofluoroscopy (VFS). Volume defects were classified as I: less than one-third, II: one-third to half, III: half to two-thirds, IV: two-thirds to total glossectomy. Location was assigned as lateral, tip, and sulcus defects. Predictors were T stage, surgical approach, volume, location, and adjuvant radiotherapy. Chi-square and logistic regression were used for statistical analysis. Defects were Class I, II, III, and IV in 36, 42, 16, and 12 patients, respectively. Adjuvant radiotherapy was given in 40% of cases. Mean evaluation time was 14 months from treatment. On, Functional Oral Intake Scale (FOIS) score, as the Class of the defect increased, the percentage of patients with low scores (poor swallowing outcomes) showed an increasing trend (p < 0.001). Defect volume, T stage, approach, and radiotherapy correlated significantly with an abnormality of all VFS parameters (p < 0.001). On multivariate analysis, defect volume remained an independent predictor for oral parameters; radiotherapy emerged as the only independent predictor for pharyngeal parameters. The incremental volume of the defect is a significant independent predictor of swallowing. Based on this, we propose a classification for glossectomy.
本研究旨在描述舌切除术患者的吞咽结局，并分析影响吞咽结局的因素。尝试提出一种分类系统，并将其与结果进行验证。这是一项横断面研究，评估接受手术治疗（有或无重建）以及根据需要接受辅助治疗的舌癌患者的吞咽情况。106 名患者接受了视频透视吞咽检查（VFSS）。容量缺损分为 I 级：小于三分之一；II 级：三分之一至一半；III 级：一半至三分之二；IV 级：三分之二至全部舌切除。位置分为外侧、舌尖和沟缺陷。预测因素包括 T 分期、手术方式、容量、位置和辅助放疗。采用卡方检验和逻辑回归进行统计学分析。36 例、42 例、16 例和 12 例患者分别存在 I、II、III 和 IV 级缺陷。40%的患者接受了辅助放疗。从治疗开始到评估的平均时间为 14 个月。FOIS 评分越高，缺陷等级越高，低评分（吞咽功能较差）的患者比例呈上升趋势（p<0.001）。缺陷体积、T 分期、手术方式和放疗与所有 VFSS 参数的异常显著相关（p<0.001）。多因素分析显示，缺陷体积是口腔参数的独立预测因素；放疗是咽部参数的唯一独立预测因素。缺陷的增量体积是吞咽的显著独立预测因素。基于此，我们提出了一种舌切除术的分类系统。
