University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
UPMC Rehabilitation Institute, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2024 Aug;134(8):3656-3663. doi: 10.1002/lary.31396. Epub 2024 Mar 19.
The purpose of this study is to determine the predictors of neck lymphedema and to explore its association with symptoms and patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients who underwent non-operative treatment.
This study involved a cross-sectional secondary analysis of data from patients diagnosed with head and neck squamous cell carcinoma who underwent radiation therapy (±chemotherapy). Patients with visits <6 weeks or >2 years following completion of radiation and those with recurrent or metastatic cancer were excluded. Presence of post-treatment lymphedema, demographics, clinical characteristics, health-related behaviors, and symptoms were collected. PROs were obtained using validated questionnaires that assessed depression, anxiety, swallowing dysfunction, and quality of life (QOL). Multivariable regression models were used to examine the relationship between lymphedema with predictors and symptoms.
Of the 203 patients included, 88 (43.4%) developed post-treatment lymphedema. In multivariable analysis, pre-treatment Body Mass Index (BMI) (odds ratio [OR] = 1.07, 95% confidence interval [CI] [1.01, 1.14] p = 0.016) and N stage (OR = 1.96, 95% CI [1.06, 3.66], p = 0.032) were found to be independently associated with lymphedema. Regarding PROs, lymphedema was associated with greater swallowing dysfunction (3.48, 95% CI [0.20, 6.75], p = 0.038), decreased mouth opening (-3.70, 95% CI [-7.31, -0.10], p = 0.044), and increased fatigue (1.88, 95% CI [1.05, 3.38], p = 0.034).
Higher pre-treatment BMI and greater N stage are identified as independent predictors for lymphedema development in non-operative HNC patients. Additionally, patients experiencing lymphedema reported worsening swallowing dysfunction and increased symptoms related to trismus and fatigue. Recognizing patients at elevated risk for lymphedema allows for early intervention, alleviation of symptom burden, and optimization of health care resources.
4 Laryngoscope, 134:3656-3663, 2024.
本研究旨在确定非手术治疗的头颈部癌症（HNC）患者颈部淋巴水肿的预测因素，并探讨其与症状和患者报告的结局（PROs）的关系。
本研究对接受放射治疗（±化疗）的头颈部鳞状细胞癌患者进行了一项横断面二次数据分析。排除了放疗完成后随访时间<6 周或>2 年的患者，以及复发或转移性癌症的患者。收集了治疗后淋巴水肿的存在、人口统计学、临床特征、健康相关行为和症状。使用经过验证的问卷评估了抑郁、焦虑、吞咽功能障碍和生活质量（QOL），获得了 PROs。多变量回归模型用于检查淋巴水肿与预测因素和症状之间的关系。
在 203 名患者中，88 名（43.4%）发生了治疗后淋巴水肿。多变量分析显示，治疗前的体重指数（BMI）（比值比[OR] = 1.07，95%置信区间[CI] [1.01，1.14]，p = 0.016）和 N 期（OR = 1.96，95% CI [1.06，3.66]，p = 0.032）与淋巴水肿独立相关。关于 PROs，淋巴水肿与更严重的吞咽功能障碍（3.48，95%CI [0.20，6.75]，p = 0.038）、张口度减小（-3.70，95%CI [-7.31，-0.10]，p = 0.044）和疲劳增加（1.88，95%CI [1.05，3.38]，p = 0.034）相关。
较高的治疗前 BMI 和更大的 N 期被确定为非手术 HNC 患者淋巴水肿发展的独立预测因素。此外，患有淋巴水肿的患者报告吞咽功能障碍恶化，以及与牙关紧闭和疲劳相关的症状增加。识别处于淋巴水肿高风险的患者可以进行早期干预，减轻症状负担，并优化医疗保健资源的利用。
4 级 Laryngoscope，134：3656-3663，2024。
