Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Otolaryngol Head Neck Surg. 2021 Jul 1;147(7):615-623. doi: 10.1001/jamaoto.2021.0698.
IMPORTANCE: Voice and speech production are critical physiological functions that affect quality of life and may deteriorate substantially after oropharyngeal cancer (OPC) treatment. There is limited knowledge about risk factors associated with voice and speech outcomes among survivors of OPC. OBJECTIVE: To identify the risk factors of voice and speech symptoms among long-term survivors of OPC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study with cross-sectional survivorship survey administration includes cancer-free survivors of OPC who were treated curatively between January 2000 and December 2013 at MD Anderson Cancer Center (Houston, Texas) who participated in a survey from September 2015 to July 2016. Of 906 survivors of OPC with a median survival duration at time of survey of 6 years (range, 1-16 years), patient-rated voice and speech outcomes for 881 were available and analyzed. The data were analyzed from June 30, 2020, to February 28, 2021. MAIN OUTCOMES AND MEASURES: The primary outcome variable was patient-reported voice and speech scores that were measured using the MD Anderson Symptom Inventory-Head and Neck Cancer Module. Voice and speech scores of 0 to 4 were categorized as none to mild symptoms, and scores of 5 to 10 were categorized as moderate to severe symptoms. Risk factors for moderate to severe voice and speech symptoms were identified by multivariable logistic regression. RESULTS: Among 881 survivors of OPC (median [range] age, 56 [32-84] years; 140 women [15.5%]; 837 White [92.4%], 17 Black [1.9%], and 35 Hispanic individuals [3.8%]), 113 (12.8%) reported moderate to severe voice and speech scores. Increasing survival time (odds ratio [OR], 1.17; 95% CI, 1.06-1.30) and increasing total radiation dose (OR, 1.16; 95% CI, 1.00-1.34), Black race (OR, 3.90; 95% CI, 1.02-14.89), Hispanic ethnicity (OR, 3.74; 95% CI, 1.50-9.35), current cigarette smoking at the time of survey (OR, 3.98; 95% CI, 1.56-10.18), treatment with induction and concurrent chemotherapy (OR, 1.94; 95% CI, 1.06-3.57), and late (OR, 7.11; 95% CI, 3.08-16.41) and baseline lower cranial neuropathy (OR, 8.70; 95% CI, 3.01-25.13) were risk factors associated with moderate to severe voice and speech symptoms. Intensity-modulated radiotherapy split-field regimen (OR, 0.31; 95% CI, 0.12-0.80; P = .01) was associated with lower likelihood of moderate to severe voice and speech symptoms. CONCLUSIONS AND RELEVANCE: This large OPC survivorship cohort study identified many treatment-related factors, including increasing total radiotherapy dose, multimodality induction and concurrent chemotherapy regimens, and continued smoking, as well as clinical and demographic factors, as risk factors that were associated with moderate to severe voice and speech symptoms. The key findings in this study were the protective associations of split-field radiation and that longer-term survivors, and those who continued to smoke, had worse voice and speech symptoms. These findings may inform research and effective targeted clinical voice and speech preservation interventions and smoking cessation interventions to maximize voice and speech function and address quality of life among patients with OPC.
重要性：发声和言语产生是影响生活质量的重要生理功能，在口咽癌（OPC）治疗后可能会严重恶化。关于 OPC 幸存者的声音和言语结果相关的风险因素的知识有限。
目的：确定 OPC 长期幸存者声音和言语症状的危险因素。
设计、地点和参与者：这是一项回顾性队列研究，结合了横断面生存调查管理，包括 2000 年 1 月至 2013 年 12 月期间在德克萨斯州休斯顿的 MD 安德森癌症中心接受根治性治疗的 OPC 无癌幸存者，他们参加了 2015 年 9 月至 2016 年 7 月的调查。在中位随访时间为 6 年（范围为 1 至 16 年）的 906 名 OPC 幸存者中，881 名患者的声音和言语结果可用并进行了分析。数据分析于 2020 年 6 月 30 日至 2021 年 2 月 28 日进行。
主要结果和措施：主要结局变量是患者报告的声音和言语评分，使用 MD 安德森症状量表 - 头颈部癌症模块进行测量。0 至 4 分的声音和言语评分被归类为无到轻度症状，5 至 10 分的声音和言语评分被归类为中度到重度症状。通过多变量逻辑回归确定中度到重度声音和言语症状的风险因素。
结果：在 881 名 OPC 幸存者中（中位[范围]年龄，56[32-84]岁；140 名女性[15.5%]；837 名白人[92.4%]，17 名黑人[1.9%]，和 35 名西班牙裔个体[3.8%]），113 名（12.8%）报告中度到重度声音和言语评分。生存时间的增加（比值比[OR]，1.17；95%置信区间[CI]，1.06-1.30）和总辐射剂量的增加（OR，1.16；95%CI，1.00-1.34）、黑人种族（OR，3.90；95%CI，1.02-14.89）、西班牙裔种族（OR，3.74；95%CI，1.50-9.35）、调查时的当前吸烟（OR，3.98；95%CI，1.56-10.18）、诱导和同期化疗（OR，1.94；95%CI，1.06-3.57）、晚期（OR，7.11；95%CI，3.08-16.41）和基线下颅神经病变（OR，8.70；95%CI，3.01-25.13）是与中度到重度声音和言语症状相关的风险因素。调强放疗分割野方案（OR，0.31；95%CI，0.12-0.80；P=0.01）与中度到重度声音和言语症状的可能性降低相关。
结论和相关性：这项大型 OPC 生存队列研究确定了许多与治疗相关的因素，包括总放射治疗剂量的增加、多模式诱导和同期化疗方案以及持续吸烟，以及临床和人口统计学因素，这些因素与中度到重度声音和言语症状相关。本研究的主要发现是分割野放疗的保护作用，以及长期幸存者和持续吸烟的患者声音和言语症状更差。这些发现可能为研究和有效的有针对性的临床声音和言语保护干预措施以及戒烟干预措施提供信息，以最大限度地提高 OPC 患者的声音和言语功能并解决生活质量问题。
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