头颈肿瘤重建术后术前衰弱-炎症表型与早期功能及患者报告恢复：一项探索性前瞻性单中心队列研究。

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中文摘要

背景/目的： 头颈重大重建术后的早期恢复并非仅由皮瓣存活决定。本探索性研究考察了术前衰弱-炎症表型是否与12周时吞咽恢复延迟、持续性营养依赖及较差的生活质量相关。方法：在一项前瞻性单中心队列研究中，84名接受头颈重大肿瘤重建术的成年人被分配至三种临床定义的表型：低风险组（n = 28）、中间组（n = 29）和合并衰弱-炎症组（n = 27）。12周结局包括功能性经口摄入量表（FOIS）、MDADI、EORTC总体健康状况、PEG依赖以及复合不良恢复终点。由于样本量小，所有估计值均报告至两位有效数字，且每项分析均被视为假设生成性。结果：与低风险组相比，合并表型组年龄更大（63 ± 9岁 vs. 55 ± 9岁），mFI-5更高（3.2 ± 0.6 vs. 1.0 ± 0.7），CRP/白蛋白比值更高（2.2 ± 0.6 vs. 0.6 ± 0.2；所有p < 0.001）。在12周时，合并表型组表现出更大的体重下降（12 ± 2%）、更低的FOIS（3.2 ± 1.3）、更低的MDADI（51 ± 7），以及52%的PEG依赖（所有p ≤ 0.002）。较高的mFI-5与不良恢复相关（每点调整OR 2.1；95% CI 1.0-4.1；p = 0.04），该估计值的置信区间宽且不精确。结论：在这个小队列中，衰弱-炎症框架与早期恢复中具有临床意义的异质性相关。这些发现是初步的，在任何临床使用之前需要前瞻性、足够把握度的多中心验证。

英文摘要

Background/Objectives: Early recovery after major head-and-neck reconstruction is not determined by flap survival alone. This exploratory study examined whether preoperative frailty-inflammatory phenotypes are associated with delayed swallowing recovery, persistent nutritional dependence, and poorer quality of life at 12 weeks. Methods: In a prospective single-center cohort study, 84 adults undergoing major head-and-neck oncologic reconstruction were assigned to three clinically defined phenotypes: low-risk (n = 28), intermediate (n = 29), and combined frailty-inflammatory (n = 27). Twelve-week outcomes included the Functional Oral Intake Scale (FOIS), MDADI, EORTC global health, PEG dependence, and a composite poor-recovery endpoint. Because of the small sample size, all estimates are reported to two significant figures, and every analysis is regarded as hypothesis-generating. Results: Compared with the low-risk group, the combined phenotype was older (63 ± 9 vs. 55 ± 9 years) and had a higher mFI-5 (3.2 ± 0.6 vs. 1.0 ± 0.7) and CRP/albumin ratio (2.2 ± 0.6 vs. 0.6 ± 0.2; all p < 0.001). At 12 weeks the combined phenotype showed greater weight loss (12 ± 2%), lower FOIS (3.2 ± 1.3), lower MDADI (51 ± 7), and PEG dependence in 52% (all p ≤ 0.002). A higher mFI-5 was associated with poor recovery (adjusted OR 2.1 per point; 95% CI 1.0-4.1; p = 0.04), an estimate whose confidence interval is wide and imprecise. Conclusions: In this small cohort a frailty-inflammatory framework was associated with clinically meaningful heterogeneity in early recovery. The findings are preliminary and require prospective, adequately powered, multicenter validation before any clinical use.