Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.
Department of Radiation Oncology, Mugla Sitki Kocman University Medical Faculty, Mugla, Turkey.
J Cancer Res Ther. 2022 Apr-Jun;18(3):638-643. doi: 10.4103/jcrt.JCRT_727_20.
The aim of this study is to determine the prognostic significance of weight loss (WL) on overall survival (OS) and progression-free survival (PFS) in patients with locally advanced unresectable laryngeal carcinoma undergoing definitive radiotherapy (RT) or chemo-RT (CRT) in a single institution.
One hundred and thirty-two patients with newly diagnosed locally advanced laryngeal carcinoma were included in this study retrospectively. All patients were treated with definitive RT or CRT. The tumor and metastatic lymph nodes received 70 Gy. Subclinical disease (low-risk and high-risk area) was irradiated 50-60 Gy prophylactically. Unintentional WL ≥5% was defined as the "critical level." Bodyweight was evaluated on the 1 day of RT and once a week during RT. Caloric needs were calculated as 25-30 kcal/kg/day.
Median follow-up was 17.8 months (range: 2.35-85 months). During treatment, there was a statistically significant WL in patients (P = 0.004). WL was ≥5% in 62 (47%) of the patients. There was a statistically significant relationship between WL and tumor differentiation (P = 0.004), completion of treatment (P = 0.004), WHO performance status (P < 0.0001), T stage (P = 0.003), N stage (P = 0.049), and supraglottic tumor location (P = 0.005). In the univariate analysis, WL, WHO performance status, T stage, N stage, tumor localization, and tumor differentiation, were seen to affect OS. Additionally, WL, WHO performance status, N stage, and tumor differentiation were prognostic factors for PFS. In the multivariate analysis, it was observed that only WL and WHO performance status were significant factors for both OS (P = 0.001, and P < 0.01) and PFS (P < 0.001, and P < 0.001), respectively. Three-year OS and PFS was 50.3% and 19.5% for patients with WL versus 77.8% and 49.0% for patients without WL.
It is clear that WL has prognostic significance in patients who have undergone definitive RT or CRT due to locally advanced laryngeal carcinoma. In particular, it should be taken into consideration that patients with supraglottic tumor, lymph node involvement, and poor performance status are at greater risk for WL.
本研究旨在确定在单一机构中接受根治性放疗（RT）或放化疗（CRT）的局部晚期不可切除喉癌患者中，体重减轻（WL）对总生存（OS）和无进展生存（PFS）的预后意义。
本研究回顾性纳入 132 例新诊断为局部晚期喉癌患者。所有患者均接受根治性 RT 或 CRT 治疗。肿瘤和转移性淋巴结接受 70Gy 照射。亚临床疾病（低危和高危区域）预防性照射 50-60Gy。未察觉的 WL≥5%定义为“临界水平”。在 RT 的第 1 天和 RT 期间每周评估一次体重。热量需求按 25-30kcal/kg/天计算。
中位随访时间为 17.8 个月（范围：2.35-85 个月）。在治疗过程中，患者的 WL 存在统计学显著差异（P=0.004）。62 例（47%）患者的 WL≥5%。WL 与肿瘤分化程度（P=0.004）、治疗完成情况（P=0.004）、世界卫生组织（WHO）表现状态（P<0.0001）、T 分期（P=0.003）、N 分期（P=0.049）和声门上肿瘤位置（P=0.005）之间存在统计学显著关系。单因素分析显示，WL、WHO 表现状态、T 分期、N 分期、肿瘤定位和肿瘤分化程度影响 OS。此外，WL、WHO 表现状态、N 分期和肿瘤分化程度是 PFS 的预后因素。多因素分析显示，只有 WL 和 WHO 表现状态是 OS（P=0.001，P<0.01）和 PFS（P<0.001，P<0.001）的显著因素。WL 的 3 年 OS 和 PFS 分别为 50.3%和 19.5%，无 WL 的 3 年 OS 和 PFS 分别为 77.8%和 49.0%。
明确的是，WL 对接受局部晚期喉癌根治性 RT 或 CRT 的患者具有预后意义。特别是，应考虑到声门上肿瘤、淋巴结受累和表现状态不佳的患者发生 WL 的风险更高。
