Riechelmann Herbert, Dejaco Daniel, Steinbichler Teresa Bernadette, Lettenbichler-Haug Anna, Anegg Maria, Ganswindt Ute, Gamerith Gabriele, Riedl David
Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Cancers (Basel). 2022 Apr 25;14(9):2135. doi: 10.3390/cancers14092135.
With the increase in long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. We reported the functional outcomes of HNC patients using the HNC-Functional InTegrity (FIT) Scales, which is a validated tool for the rapid clinical assessment of functional status based on observable clinical criteria. Patients with newly diagnosed HNC treated at the Medical University of Innsbruck between 2008 and 2020 were consecutively included, and their status in the six functional domains of food-intake, breathing, speech, pain, mood, and neck and shoulder mobility was scored by the treating physician at oncological follow-up visits on a scale from 0 (loss of function) to 4 (full function). HNC-FIT scales were available for 681 HNC patients at a median of 35 months after diagnosis. The response status was complete remission in 79.5%, 18.1% had recurrent or persistent disease, and 2.4% had a second primary HNC. Normal or near-normal scores (3 and 4) were seen in 78.6% for food intake, 88.7% for breathing, 83.7% for speech, 89% for pain, 91.8% for mood, and 87.5% for neck and shoulder mobility. A normal or near-normal outcome in all six functional domains was observed in 61% of patients. Clinically relevant impairment (score 1-2) in at least one functional domain was observed in 30%, and 9% had loss of function (score 0) in at least one functional domain. The main factors associated with poor functional outcome in a multivariable analysis were recurrence or persistent disease, poor general health (ASA III and IV), and higher T stage. Particularly, laryngeal and hypopharyngeal tumors impaired breathing and speech function, and primary radiation therapy or concomitant systemic therapy and radiotherapy worsened food intake. Clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of the patients with HNC. The treatment of these functional deficits is an essential task of oncologic follow-up.
随着头颈癌（HNC）长期生存率的提高，功能预后变得愈发重要。我们使用HNC功能完整性（FIT）量表报告了HNC患者的功能预后情况，该量表是一种基于可观察临床标准对功能状态进行快速临床评估的有效工具。连续纳入了2008年至2020年期间在因斯布鲁克医科大学接受治疗的新诊断HNC患者，其食物摄入、呼吸、言语、疼痛、情绪以及颈部和肩部活动这六个功能领域的状态由主治医生在肿瘤学随访时根据0（功能丧失）至4（功能完全正常）的量表进行评分。在诊断后中位35个月时，681例HNC患者可获得HNC-FIT量表评分。缓解状态为完全缓解的占79.5%，18.1%有复发或持续性疾病，2.4%有第二原发性HNC。食物摄入方面78.6%、呼吸方面88.7%、言语方面83.7%、疼痛方面89%、情绪方面91.8%以及颈部和肩部活动方面87.5%的患者获得正常或接近正常评分（3分和4分）。61%的患者在所有六个功能领域均获得正常或接近正常结果。30%的患者在至少一个功能领域存在临床相关损害（评分1 - 2分），9%的患者在至少一个功能领域存在功能丧失（评分0分）。多变量分析中与功能预后不良相关的主要因素为复发或持续性疾病、一般健康状况差（美国麻醉医师协会身体状况分级III级和IV级）以及T分期较高。特别是，喉癌和下咽癌会损害呼吸和言语功能，而单纯放疗或同步全身治疗及放疗会使食物摄入情况恶化。预计40%的HNC患者在至少一个功能领域会出现临床相关的持续性功能缺陷。对这些功能缺陷的治疗是肿瘤学随访的一项重要任务。
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