Yamaguchi T, Makiguchi T, Nakamura H, Yamatsu Y, Hirai Y, Shoda K, Suzuki K, Kim M, Kurozumi S, Motegi S I, Shirabe K, Yokoo S
Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Int J Oral Maxillofac Surg. 2021 Sep;50(9):1195-1202. doi: 10.1016/j.ijom.2020.12.005. Epub 2021 Jan 4.
This study evaluated the association between skeletal muscle mass depletion and severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection. Skeletal muscle mass was evaluated in 60 patients using the skeletal muscle index, which was based on skeletal muscle cross-sectional area (on computed tomography) at the level of the third lumbar vertebra. In accordance with the grading criteria of the Radiation Therapy Oncology Group, patients with a grade ≥3 were defined as having severe oral mucositis. Multivariate logistic regression analysis was used to evaluate independent risk factors for severe oral mucositis. Eleven patients (18.3%) were diagnosed with low skeletal muscle mass. Severe oral mucositis occurred in 17 (28.3%) patients, and the mean skeletal muscle index was 42.8 cm/m. A low skeletal muscle mass (hazard ratio 18.1; P=0.001) and a chemotherapy regimen consisting of 5-fluorouracil and cisplatin (versus cisplatin only) (hazard ratio 5.5; P=0.015) were independent risk factors for severe oral mucositis. Future prospective studies are warranted to identify effective pre- and perioperative exercises and nutrition programmes to increase low skeletal muscle mass and reduce the incidence of severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection.
本研究评估了口腔癌切除术后接受同步放化疗患者的骨骼肌质量消耗与严重口腔黏膜炎之间的关联。使用骨骼肌指数对60例患者的骨骼肌质量进行评估，该指数基于第三腰椎水平的骨骼肌横截面积（通过计算机断层扫描）。根据放射肿瘤学组的分级标准，≥3级的患者被定义为患有严重口腔黏膜炎。采用多因素逻辑回归分析评估严重口腔黏膜炎的独立危险因素。11例患者（18.3%）被诊断为骨骼肌质量低。17例（28.3%）患者发生严重口腔黏膜炎，平均骨骼肌指数为42.8 cm/m²。骨骼肌质量低（风险比18.1；P=0.001）以及由5-氟尿嘧啶和顺铂组成的化疗方案（与仅使用顺铂相比）（风险比5.5；P=0.015）是严重口腔黏膜炎的独立危险因素。有必要开展未来的前瞻性研究，以确定有效的术前和围手术期运动及营养方案，以增加低骨骼肌质量，并降低口腔癌切除术后接受同步放化疗患者严重口腔黏膜炎的发生率。
