头颈癌患者接受根治性放疗的患者报告结局测量：基于头颈5000队列的研究

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中文摘要

目的： 我们利用头颈5000（HN5000）队列，评估年龄≥70岁和世界卫生组织（WHO）体能状态（PS）≥2是否与患者报告的急性、晚期和极晚期毒性严重程度增加或完成规定放疗（RT）疗程（伴或不伴同期全身抗癌治疗（SACT））的比例降低相关，这些患者因口腔、口咽和喉癌接受根治性治疗。
材料与方法： 纳入接受根治性或辅助性RT伴/不伴同期SACT的参与者。基线特征采用卡方检验和Wilcoxon秩和检验进行分析。患者报告结局（PROs）按年龄<70岁 vs ≥70岁，以及PS<2 vs PS≥2进行分层，并按头颈癌（HNC）肿瘤亚部位和作为总体队列，使用纵向建模、多变量分析和敏感性分析在所有时间点进行研究。计算完成RT的比值比，并使用Fisher精确检验评估差异。
结果： 共有3250名患者纳入年龄组分析，2295名纳入PS分析。PROs报告随时间减少，尤其是在PS≥2组；1971名纳入多变量分析。≥70岁的参与者报告的症状严重程度与<70岁者相似或更低。与PS<2者相比，PS≥2者中高PRO评分 consistently 更常见，且恢复通常更慢、更差。无论年龄或PS如何，RT完成率非常高，>97%完成根治性RT，>94%完成辅助性RT。
结论： 年龄似乎不是HNC根治性RT后PROs的负面预后因素。尽管报告了更高的毒性，令人惊讶的是，PS≥2患者通常仍完成了根治性RT疗程。在HNC发病率增加的老龄化人群中，需要更详细的研究以更好地指导我们对这一代表性不足的患者队列的临床管理。

英文摘要

AIMS: We used the Head and Neck 5000 (HN5000) cohort to assess whether age ≥70 yrs and World Health Organization (WHO) performance status (PS) ≥2 were associated with increased severity of patient-reported acute, late, and very late toxicity or reduced rate of completing a prescribed course of radiotherapy (RT) with or without concurrent systemic anticancer treatment (SACT) in patients undergoing radical treatment for oral cavity, oropharyngeal, and laryngeal cancer.
MATERIALS AND METHODS: Participants treated with definitive or adjuvant RT with/without concurrent SACT were included. Baseline characteristics were analysed with the chisquared and Wilcoxon rank-sum test. Patient-reported outcomes (PROs) were stratified into age <70 yrs vs ≥70 yrs, and PS <2 vs PS ≥2 and investigated across all timepoints per head and neck cancer (HNC) tumour subsite and as an overall cohort using longitudinal modelling, multivariable analysis, and sensitivity analysis. The odds of completing the RT rate was calculated, and differences were assessed using Fisher's exact test.
RESULTS: A total of 3250 patients were included in the age-group analysis, and 2295 were included in the PS analysis. PROs reporting reduced over time, especially for the PS ≥2 group; 1971 were included in the multivariable analysis. Participants ≥70 yrs reported symptom severity similar to or lower than those <70 yrs. High PRO scores were consistently more likely among those who were PS ≥2 compared with PS <2, and recovery was generally slower and poorer. Completion rates of RT were very high, regardless of age or PS, with >97% completing definitive and >94% completing adjuvant RT.
CONCLUSION: Age does not appear to be a negative prognostic factor for PROs following radical RT for HNC. Despite reporting higher toxicity, surprisingly, PS ≥2 patients often completed a radical RT course regardless. In an ageing population with an increasing incidence of HNC, more detailed research is required to better inform our clinical management of this underrepresented patient cohort.