头颈癌治疗前健康相关生活质量与生存：一项荟萃分析
Pretreatment Health-Related Quality of Life and Survival in Head and Neck Cancer: A Meta-Analysis.
文献信息
| PMID | 42830661 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | YuJie Hu |
| 作者单位 | Department of Radiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 量化头颈癌治疗前患者报告的健康相关生活质量（HRQoL）各领域与总生存之间的关联。
数据来源： 检索PubMed、Embase和Web of Science，自建库至2026年7月27日。
综述方法： 纳入将经过验证的患者报告HRQoL作为预后暴露因素进行评估的纵向研究。将总生存的校正风险比（HR）统一为每恶化10分的效应量，并按领域采用限制性最大似然随机效应模型进行合并。评估了偏倚风险、多重性、留一法稳定性、队列重叠、残余混杂敏感性以及报告完整性。
结果： 共纳入40篇出版物中的32项独立研究；43个估计值纳入10个领域的荟萃分析。较差的总体生活质量（HR，1.11；95% CI，1.08-1.14）、躯体功能（1.16；1.13-1.20）、角色功能（1.09；1.07-1.11）和社会功能（1.09；1.06-1.12）与更高的死亡率一致相关，且留一法分析稳定。吞咽与死亡率相关（1.15；1.02-1.29），但对单项研究敏感。呼吸困难在主分析中与更高的死亡率相关（4项研究；HR，1.16；95% CI，1.01-1.33），但该估计值存在异质性且不稳定。
结论： 治疗前HRQoL提供多维度的预后信息，其中总体生活质量以及躯体、角色、情感和社会功能显示出最一致的证据。这些领域可能有助于确定治疗前支持性照护评估的优先顺序，而敏感性受限或极低确定性的发现需要进一步确认，不应被解读为可操作的治疗靶点。
证据等级： 不适用。
试验注册： PROSPERO注册号：CRD420261461389。
英文摘要
OBJECTIVE: To quantify associations between pretreatment patient-reported health-related quality of life (HRQoL) domains and overall survival in head and neck cancer.
DATA SOURCES: PubMed, Embase, and Web of Science were searched from inception through July 27, 2026.
REVIEW METHODS: Longitudinal studies evaluating validated patient-reported HRQoL as a prognostic exposure were included. Adjusted hazard ratios (HRs) for overall survival were harmonized to a 10-point worsening and pooled by domain using restricted maximum-likelihood random-effects models. Risk of bias, multiplicity, leave-one-out stability, cohort overlap, residual-confounding sensitivity, and reporting completeness were evaluated.
RESULTS: Thirty-two independent studies in 40 publications were included; 43 estimates contributed to meta-analyses of 10 domains. Worse Global QoL (HR, 1.11; 95% CI, 1.08-1.14), physical functioning (1.16; 1.13-1.20), role functioning (1.09; 1.07-1.11), and social functioning (1.09; 1.06-1.12) were consistently associated with higher mortality and remained leave-one-out stable. Swallowing was associated with mortality (1.15; 1.02-1.29) but was sensitive to one study. Dyspnea was associated with higher mortality in the primary analysis (4 studies; HR, 1.16; 95% CI, 1.01-1.33), but the estimate was heterogeneous and unstable.
CONCLUSION: Pretreatment HRQoL provides multidimensional prognostic information, with Global QoL and physical, role, emotional, and social functioning showing the most consistent evidence. These domains may help prioritize pretreatment supportive-care assessment, whereas sensitivity-limited or very-low-certainty findings require further confirmation and should not be interpreted as actionable treatment targets.
LEVEL OF EVIDENCE: N/A.
TRIAL REGISTRATION: PROSPERO number: CRD420261461389.