University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany.
University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Germany.
Radiother Oncol. 2022 Jan;166:145-153. doi: 10.1016/j.radonc.2021.11.011. Epub 2021 Nov 25.
To analyze the impact of quality of life (QoL), nutritional and clinical indicators on overall survival in patients with head and neck squamous cell cancer (HNSCC) undergoing (chemo)radiotherapy.
At the beginning, at the end of (chemo)radiotherapy and during follow-up, QoL was prospectively assessed using the EORTC-QLQ-C30 and -QLQ-H&N35 questionnaires. Data were analyzed in 58 out of 220 screened patients, who were randomized into a control and intervention group. All patients received a nutritional assessment including bioelectrical impedance analysis (BIA), laboratory testing, and a screening for malnutrition based on the questionnaires MUST, NRS-2002 and Nutriscore at baseline and at the end of therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks.
Except for emotional functioning, dyspnea, financial difficulties, dental problems and weight gain, all other scales from the EORTC-QLQ-C30 and -H&N35 deteriorated during (chemo)radiotherapy. At first follow-up, patients of the control group experienced more nausea and vomiting compared to those of the intervention group (p = 0.02). After performing a multivariable model, dental problems at the end of therapy (HR: 1.03; 95% CI: 1-1.06; p = 0.03), HPV negativity (HR: 18.19, 95% CI: 1.61-204.17; p = 0.02), and baseline phase angle (HR: 0.09; 95% CI: 0.01-0.82; p = 0.03) were identified as predictors for overall survival.
Factors influencing overall survival in patients with HNSCC undergoing (chemo)radiotherapy are complex and multifactorial. We were able to identify QoL-related (dental problems), clinical (HPV status) and nutritional (phase angle) factors as negative predictors for survival. This study was registered within the German Clinical Trials Register (DRKS00016862).
分析生活质量（QoL）、营养和临床指标对接受放化疗的头颈部鳞状细胞癌（HNSCC）患者总生存期的影响。
在开始、结束放化疗期间和随访期间，使用 EORTC-QLQ-C30 和 -QLQ-H&N35 问卷对 QoL 进行前瞻性评估。在 220 名筛选出的患者中，有 58 名患者的数据进行了分析，他们被随机分为对照组和干预组。所有患者均接受营养评估，包括生物电阻抗分析（BIA）、实验室检查以及根据 MUST、NRS-2002 和 Nutriscore 问卷对营养不良进行筛查，在基线和治疗结束时进行。干预措施包括每 2 周进行一次个体化营养咨询。
除情绪功能、呼吸困难、经济困难、牙科问题和体重增加外，EORTC-QLQ-C30 和 -H&N35 的所有其他量表在放化疗期间均恶化。在首次随访时，对照组患者的恶心和呕吐发生率高于干预组（p=0.02）。进行多变量模型后，治疗结束时的牙科问题（HR：1.03；95%CI：1-1.06；p=0.03）、HPV 阴性（HR：18.19，95%CI：1.61-204.17；p=0.02）和基线时的相位角（HR：0.09；95%CI：0.01-0.82；p=0.03）被确定为总生存期的预测因子。
影响接受放化疗的 HNSCC 患者总生存期的因素复杂且多因素。我们能够确定与 QoL 相关的（牙科问题）、临床（HPV 状态）和营养（相位角）因素作为生存的负预测因子。本研究在德国临床试验注册处（DRKS00016862）注册。
