Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Radiother Oncol. 2023 Mar;180:109465. doi: 10.1016/j.radonc.2023.109465. Epub 2023 Jan 11.
Post-treatment symptoms are a focal point of follow-up visits for head and neck cancer patients. While symptoms such as dysphagia and shortness-of-breath early after treatment may motivate additional work up, their precise association with disease control and survival outcomes is not well established.
This prospective data cohort study of 470 oropharyngeal cancer patients analyzed patient-reported swallowing, choking and shortness-of-breath symptoms at 3-to-6 months following radiotherapy to evaluate their association with overall survival and disease control. Associations between the presence of moderate-to-severe swallowing, choking and mild-to-severe shortness-of-breath and treatment outcomes were analyzed via Cox regression and Kaplan-Meier. The main outcome was overall survival (OS), and the secondary outcomes were local, regional, and distant disease control.
The majority of patients (91.3%) were HPV-positive. Median follow-up time was 31.7 months (IQR: 21.9-42.1). Univariable analysis showed significant associations between OS and all three symptoms of swallowing, choking, and shortness-of-breath. A composite variable integrating scores of all three symptoms was significantly associated with OS on multivariable Cox regression (p = 0.0018). Additionally, this composite symptom score showed the best predictive value for OS (c-index = 0.75). Multivariable analysis also revealed that the composite score was significantly associated with local (p = 0.044) and distant (p = 0.035) recurrence/progression. Notably, the same significant associations with OS were seen for HPV-positive only subset analysis (p < 0.01 for all symptoms).
Quantitative patient-reported measures of dysphagia and shortness-of-breath 3-to-6 months post-treatment are significant predictors of OS and disease recurrence/progression in OPC patients and in HPV-positive OPC only.
治疗后症状是头颈部癌症患者随访的重点。虽然治疗后早期出现的吞咽困难和呼吸急促等症状可能会促使进行更多的检查，但它们与疾病控制和生存结果的确切关联尚未得到很好的确立。
本前瞻性数据队列研究纳入了 470 例口咽癌患者，分析了这些患者在放疗后 3-6 个月时报告的吞咽、哽噎和呼吸急促症状，以评估这些症状与总生存和疾病控制的关系。通过 Cox 回归和 Kaplan-Meier 分析了中度至重度吞咽、哽噎和轻度至重度呼吸急促的存在与治疗结果之间的关系。主要结局为总生存（OS），次要结局为局部、区域和远处疾病控制。
大多数患者（91.3%）HPV 阳性。中位随访时间为 31.7 个月（IQR：21.9-42.1）。单变量分析显示，OS 与吞咽、哽噎和呼吸急促这三种症状均显著相关。多变量 Cox 回归分析显示，综合所有三种症状评分的变量与 OS 显著相关（p=0.0018）。此外，该综合症状评分对 OS 具有最佳的预测价值（c 指数=0.75）。多变量分析还显示，该综合评分与局部（p=0.044）和远处（p=0.035）复发/进展显著相关。值得注意的是，在 HPV 阳性患者亚组分析中也观察到与 OS 显著相关的结果（所有症状的 p 值均<0.01）。
治疗后 3-6 个月时定量的患者报告的吞咽困难和呼吸急促测量值是 OPC 患者和仅 HPV 阳性 OPC 患者 OS 和疾病复发/进展的显著预测指标。
