Liou Hsin-Hao, Hsieh Miyuki Hsing-Chun, Tsai Sheng-Han, Hung David Shang-Yu, Chen Yi-Jen, Hsiao Jenn-Ren, Huang Cheng-Chih, Ou Chun-Yen, Chang Chan-Chi, Lee Wei-Ting, Tsai Sen-Tien, Tsai Shu-Wei
Department of Otolaryngology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 6F., No. 138, Shengli Rd., East Dist, Tainan, 70403, Taiwan.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Dysphagia. 2023 Apr;38(2):700-710. doi: 10.1007/s00455-022-10501-w. Epub 2022 Aug 11.
Dysphagia affects 60-75% of patients treated for head and neck cancer (HNC). We aimed to evaluate the association between residue severity and airway invasion severity using a videofluoroscopic swallowing study and identify risk factors for poor penetration-aspiration outcomes in patients with dysphagia treated for HNC. Penetration-Aspiration Scale (PAS) was used to assess airway invasion severity, while residue severity was assessed using both the Bolus Residue Scale (BRS) for residue location and the Normalized Residue Ratio Scale (NRRS) for residue amount. Relevant covariates were adjusted in the logistic regression models to account for potential confounding. Significantly higher abnormal PAS was reported for increased piriform sinus NRRS (NRRSp) [odds ratio (OR), 4.81; p = 0.042] with liquid swallowing and increased BRS value (OR, 1.52; p = 0.014) for semi-liquid swallowing in multivariate analysis. Tumor location, older age, and poorer Functional Oral Intake Scale (FOIS) were significant factors for abnormal PAS in both texture swallowings. After adjusting for confounding factors (sex, age, and FOIS score), NRRS model in liquid swallowing (area under the curve [AUC], 0.83; standard error = 0.04, 95% confidence interval [CI]: 0.75, 0.91) and BRS in semi-liquid swallowing (AUC, 0.83; SE = 0.04; 95% CI: 0.76, 0.91) predicted abnormal PAS. The results indicate that while assessing residue and swallowing aspiration in patients with HNC, it is important to consider age, tumor location, and functional swallowing status. The good predictability of abnormal PAS with BRS and NRRS indicated that residue location and amount were both related to the aspiration event in patients with HNC.
吞咽困难影响60%-75%的头颈癌（HNC）患者。我们旨在通过视频荧光吞咽造影研究评估残留严重程度与气道侵犯严重程度之间的关联，并确定HNC吞咽困难患者穿透-误吸不良结局的危险因素。采用穿透-误吸量表（PAS）评估气道侵犯严重程度，同时使用团块残留量表（BRS）评估残留位置，使用标准化残留比率量表（NRRS）评估残留量。在逻辑回归模型中对相关协变量进行调整以考虑潜在的混杂因素。多因素分析显示，梨状窝NRRS（NRRSp）升高时，液体吞咽的异常PAS显著升高[比值比（OR），4.81；p = 0.042]，半液体吞咽时BRS值升高（OR，1.52；p = 0.014）。在两种质地吞咽中，肿瘤位置、年龄较大和功能口服摄入量量表（FOIS）较差都是异常PAS的显著因素。在调整混杂因素（性别、年龄和FOIS评分）后，液体吞咽中的NRRS模型（曲线下面积[AUC]，0.83；标准误 = 0.04，95%置信区间[CI]：0.75，0.91）和半液体吞咽中的BRS（AUC，0.83；SE = 0.04；95% CI：0.76，0.91）可预测异常PAS。结果表明，在评估HNC患者的残留和吞咽误吸时，考虑年龄、肿瘤位置和功能性吞咽状态很重要。BRS和NRRS对异常PAS的良好预测性表明，残留位置和量均与HNC患者的误吸事件有关。
