Farrugia Mark, Yu Han, Ma Sung Jun, Iovoli Austin J, Attwood Kristopher, Wooten Kimberly E, Arshad Hassan, Gupta Vishal, McSpadden Ryan P, Kuriakose Moni A, Markiewicz Michael R, Chan Jon M, Hicks Wesley L, Platek Mary E, Ray Andrew D, Repasky Elizabeth A, Singh Anurag K
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA.
Cancers (Basel). 2021 Mar 8;13(5):1155. doi: 10.3390/cancers13051155.
Health-related quality of life (HRQOL) metrics can be associated with survival in head and neck cancer (HNC); however, the impact of HRQOL recovery and the relevant HRQOL domains regarding outcome are unclear.
Using a single-institution database, we retrospectively reviewed HNC patients treated with definitive or postoperative radiation therapy between 2013 and 2018. The recovery of individual HRQOL domains were determined by the ratio of the post-treatment to baseline scores. Univariate and Multivariate Cox regression were used to analyze survival outcomes. Principal component analysis was used to adjust for multicollinearity of HRQOL domains.
In 218 HNC patients who received radiation therapy, median follow-up was 24.8 months (interquartile range (IQR) 14.5-32.0). Principal component analysis evaluating the recovery of HRQOL domains revealed two independent principal components (PC), PC1 and PC2. PC1, which received contributions from the functional domains; physical (PF), role (RF), emotional (EF), cognitive (CF), and global health status (GQOL) was significantly associated with disease-free (HR = 0.77, 95% CI 0.61-0.98, = 0.034) and overall survival (HR = 0.76, 95% CI 0.65-0.91, = 0.004) on multivariate analysis and PC2, had no correlation with outcome and was mainly represented by social functioning. Unplanned hospitalization was significantly associated with lower PC1 scores (β = -0.997, Std. Error = 0.244, < 0.001).
Our study provides evidence that post-treatment recovery of HRQOL domains were associated with overall survival (OS) in HNC. PC1 is an attractive clinical tool to assess the recovery across multiple different HRQOL and the relationship with survival. Future prospective studies may identify patients who could benefit from additional rehabilitation based on PC1 score.
健康相关生活质量（HRQOL）指标可能与头颈癌（HNC）的生存相关；然而，HRQOL恢复的影响以及与结局相关的HRQOL领域尚不清楚。
利用单机构数据库，我们回顾性分析了2013年至2018年间接受根治性或术后放射治疗的HNC患者。通过治疗后与基线评分的比值来确定各个HRQOL领域的恢复情况。采用单因素和多因素Cox回归分析生存结局。主成分分析用于调整HRQOL领域的多重共线性。
在218例接受放射治疗的HNC患者中，中位随访时间为24.8个月（四分位间距（IQR）14.5 - 32.0）。评估HRQOL领域恢复情况的主成分分析显示有两个独立的主成分（PC），即PC1和PC2。PC1从功能领域获得贡献，包括身体（PF）、角色（RF）、情感（EF）、认知（CF）和总体健康状况（GQOL），在多因素分析中与无病生存（HR = 0.77，95% CI 0.61 - 0.98，P = 0.034）和总生存（HR = 0.76，95% CI 0.65 - 0.91，P = 0.004）显著相关，而PC2与结局无相关性，主要由社会功能代表。非计划住院与较低的PC1评分显著相关（β = -0.997，标准误 = 0.244，P < 0.001）。
我们的研究提供了证据表明，HNC患者治疗后HRQOL领域的恢复与总生存（OS）相关。PC1是评估多个不同HRQOL恢复情况及其与生存关系的有吸引力的临床工具。未来的前瞻性研究可能会根据PC1评分识别出可能从额外康复中获益的患者。
