Ghazali Siti Nur Akmal, Manan Hanani Abdul, Chan Caryn Mei Hsien, Eezamuddeen Marfu'ah Nik, Yahya Noorazrul
Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, CODTIS, National University of Malaysia, Jalan Raja Muda Aziz, 50300, Kuala Lumpur, Malaysia.
Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000, Kuala Lumpur, Malaysia.
Qual Life Res. 2025 Apr 11. doi: 10.1007/s11136-025-03933-y.
The association between health-related quality of life (HQoL) and overall survival (OS) among head and neck cancer (HNC) patients remains an important yet complex topic. This study aims to comprehensively analyze the prognostic effects of HQoL indices and symptoms-specific outcomes on overall survival in HNC patients.
A systematic literature search was conducted in PubMed, Web of Science and Scopus databases. The QUIPS tool was used to assess the risk of bias in the prognostic studies. The variables from the HQoL assessments included as predictors of OS were recorded. Different phases of measurements either pre or post-treatment (3 to > 12 months after completion) were also classified to observe the patterns. This review utilized a proposed best-evidence synthesis in which the consistency of significant results from multivariate analysis was observed. Each index that shows > 75% proportion of high-quality studies with same result is classified as strong evidence.
Following an extensive search yielding 440 articles, the rigorous screening process identified 32 studies involving 12,206 HNC patients. This review underscores the pivotal role of higher post-treatment physical functioning predicting OS, which is supported by strong evidence and consistent findings. Three indices showed moderate evidence which are pretreatment physical function, post-treatment general HQoL and post-treatment social function. Notably, the analysis revealed that specific general-cancer symptoms, including appetite loss and dyspnea, were reported in association with OS in seven out of 33 instances, following multivariate analysis. Furthermore, the study highlighted the significance of social eating and problems with swallowing as predictors of OS (≥ 5 times instances) compared to other HNC symptoms-specific outcomes.
This study sheds light on the underexplored role of post-treatment physical function as predictors for OS, complementing the well-discussed pretreatment physical function. It identifies four specific symptoms significantly impacting OS, highlighting the need for effective management strategies.
头颈部癌（HNC）患者的健康相关生活质量（HQoL）与总生存期（OS）之间的关联仍是一个重要但复杂的话题。本研究旨在全面分析HQoL指标和症状特异性结果对HNC患者总生存期的预后影响。
在PubMed、科学网和Scopus数据库中进行了系统的文献检索。使用QUIPS工具评估预后研究中的偏倚风险。记录来自HQoL评估的作为OS预测指标的变量。还对治疗前或治疗后（完成后3至＞12个月）测量的不同阶段进行了分类，以观察其模式。本综述采用了一种提议的最佳证据综合法，观察多变量分析中显著结果的一致性。每个显示＞75%的高质量研究结果相同的指标被归类为有力证据。
经过广泛检索得到440篇文章，严格的筛选过程确定了32项研究，涉及12206例HNC患者。本综述强调了治疗后更高的身体功能对预测OS的关键作用，这得到了有力证据和一致结果的支持。三个指标显示出中等证据，即治疗前身体功能、治疗后总体HQoL和治疗后社会功能。值得注意的是，分析显示，在33例中的7例中，多变量分析后报告特定的一般癌症症状，包括食欲减退和呼吸困难，与OS相关。此外，该研究强调了与其他HNC症状特异性结果相比，社交进食和吞咽问题作为OS预测指标的重要性（≥5次实例）。
本研究揭示了治疗后身体功能作为OS预测指标的未被充分探索的作用，补充了已充分讨论的治疗前身体功能。它确定了四个显著影响OS的特定症状，突出了有效管理策略的必要性。
