Kidane Joseph, Laus Joey, Gulati Arushi, Gochman Grant E, Schneider Sarah L, Chan Jason W, Yom Sue S, Ha Patrick, Boscardin W John, Ryan William R, Ma Yue
School of Medicine, University of California San Francisco, San Francisco, California, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A.
Laryngoscope. 2023 Jun;133(6):1339-1348. doi: 10.1002/lary.30355. Epub 2022 Aug 29.
BACKGROUND/OBJECTIVE: Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these measurements and correlate them with functional swallowing outcomes.
A retrospective review was conducted on patients with OPSCC treated with definitive (chemo)radiation ([C]RT) or surgery with adjuvant (chemo)radiation (S-[C]RT) who completed at least two videofluoroscopic swallow studies (VFSS). Longitudinal analysis was accomplished via mixed-effects logistic regression for the Functional Oral Intake Scale (FOIS), and Penetration Aspiration Scale (PAS), and mixed-effects linear regression for kinematic measures. Spearman's correlation was conducted between changes in FOIS/PAS and kinematic measures.
Ninety-seven patients (76 males; mean age 61) completed 245 VFSS studies. A total of 94% had human papillomavirus (HPV)/p16 positive OPSCC and 74% were T0-T2. Sixty-four patients underwent [C]RT while 33 patients underwent S-[C]RT. After treatment, posterior pharyngeal wall at hold (PPWhold) increased 3.2 standard deviation (SD) between 0 and 6 months (p < 0.001), then decreased 2.2 SD between 6 and 12 months (p < 0.001) and did not return to baseline. Hyoid-to-larynx (HL) (p = 0.046) and maximal hyoid displacement (Hmax) + HL (p = 0.042) increased between 6 and 12 months. Hmax (p = 0.020) and Hmax + HL (p < 0.001) decreased between 12-24 months beyond baseline values. The decrease in HL and increase in PPWhold (p < 0.05) correlated with an increase in PAS. From baseline, increased pharyngeal constriction ratio correlated with decreased FOIS and PPWhold (p < 0.05).
Quantitative swallowing kinematic measures can effectively track changes in swallowing physiology. Increased PPWhold and restricted hyolaryngeal movement were seen in patients with OPSCC after treatment and correlated with a change in swallowing outcome, emphasizing the need for serial VFSS monitoring and targeted intervention.
3 Laryngoscope, 133:1339-1348, 2023.
背景/目的：口咽鳞状细胞癌（OPSCC）患者的定量吞咽移位运动学有所发展。我们旨在纵向评估这些测量指标，并将它们与吞咽功能结果相关联。
对接受根治性（化疗）放疗（[C]RT）或手术联合辅助（化疗）放疗（S-[C]RT）且完成至少两次视频荧光吞咽造影检查（VFSS）的OPSCC患者进行回顾性研究。通过对功能性经口进食量表（FOIS）和渗透误吸量表（PAS）进行混合效应逻辑回归，以及对运动学指标进行混合效应线性回归来完成纵向分析。对FOIS/PAS的变化与运动学指标进行Spearman相关性分析。
97例患者（76例男性；平均年龄61岁）完成了245次VFSS检查。总共94%的患者为人类乳头瘤病毒（HPV）/p16阳性的OPSCC，74%为T0-T2期。64例患者接受了[C]RT，33例患者接受了S-[C]RT。治疗后，静息时咽后壁（PPWhold）在0至6个月之间增加了3.2个标准差（SD）（p < 0.001），然后在6至12个月之间下降了2.2个SD（p < 0.001），且未恢复到基线水平。舌骨至喉（HL）（p = 0.046）和最大舌骨移位（Hmax）+ HL（p = 0.042）在6至12个月之间增加。Hmax（p = 0.020）和Hmax + HL（p < 0.001）在超过基线值的12至24个月之间下降。HL的下降和PPWhold的增加（p < 0.05）与PAS的增加相关。与基线相比，咽缩窄率的增加与FOIS和PPWhold的降低相关（p < 0.05）。
定量吞咽运动学指标可以有效追踪吞咽生理的变化。OPSCC患者治疗后出现PPWhold增加和舌骨喉运动受限，且与吞咽结果的变化相关，强调了连续VFSS监测和针对性干预的必要性。
3 《喉镜》，133:1339 - 1348，2023年。
