低血清白蛋白、体重指数和喂养途径预测头颈癌同步放化疗期间的治疗中断：一项回顾性队列研究。
Low Serum Albumin, Body Mass Index, and Feeding Route Predict Treatment Interruptions During Concurrent Chemoradiotherapy in Head and Neck Cancer: A Retrospective Cohort Study.
文献信息
| PMID | 42870793 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kitti Jantharapattana |
| 作者单位 | Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand. |
| 期刊 | Laryngoscope investigative otolaryngology |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 确定同步放化疗（CCRT）期间治疗中断的营养相关预测因素（主要结局），并确定中断对5年总生存期（OS）的次要影响。
方法： 这项回顾性队列研究分析了2013年1月至2016年12月在一家三级学术中心接受根治性CCRT的440例头颈癌（HNC）患者。治疗中断定义为放疗总治疗时间>56天或累积延迟>7天，以及化疗延迟>7天或提前终止。多变量逻辑回归确定独立预测因素；Kaplan-Meier分析按中断状态和肿瘤部位比较5年OS。
结果： 在440例患者中（平均年龄55岁；81.7%为男性），52.3%经历化疗中断，14.4%经历放疗中断。化疗中断的独立营养预测因素为：血清白蛋白<3.5 g/dL（调整OR 2.54，95% CI 1.19-5.43，p=0.016）、治疗前BMI类别（总体p=0.032，主要由BMI>25 kg/m2的保护趋势驱动[调整OR 0.55，95% CI 0.30-1.00，p=0.051]；<18.5 kg/m2亚组显示风险非显著性增加：调整OR 1.41，95% CI 0.84-2.35，p=0.196），以及经口喂养（vs. 喂养管作为参考）（调整OR 2.27，95% CI 1.07-4.76，p=0.030）。在非鼻咽癌中，放疗中断显著降低5年OS（14.3% vs. 29.9%，p=0.03）。化疗中断未显著影响生存。
结论： 低白蛋白血症（<3.5 g/dL）、治疗前BMI类别和喂养途径独立预测HNC中的化疗中断。放疗中断显著损害非鼻咽癌患者的生存。这些易于获得的标志物应指导高危患者的治疗前营养优化和喂养管考虑。
英文摘要
OBJECTIVE: To identify nutrition-related predictors of treatment interruption during concurrent chemoradiotherapy (CCRT), the primary outcome and to determine the secondary impact of interruption on 5-year overall survival (OS).
METHODS: This retrospective cohort study analyzed 440 head and neck cancer (HNC) patients receiving definitive CCRT (January 2013 to December 2016) at a tertiary academic center. Treatment interruption was defined as radiotherapy total treatment time > 56 days or cumulative delay > 7 days, and as chemotherapy delay > 7 days or premature discontinuation. Multivariable logistic regression identified independent predictors; Kaplan-Meier analysis compared 5-year OS by interruption status and tumor site.
RESULTS: Among 440 patients (mean age 55 years; 81.7% male), 52.3% experienced chemotherapy interruptions and 14.4% radiotherapy interruptions. Independent nutritional predictors of chemotherapy interruption were: serum albumin < 3.5 g/dL (adjusted OR 2.54, 95% CI 1.19-5.43, p = 0.016), pretreatment BMI category (overall p = 0.032, driven mainly by a protective trend for BMI > 25 kg/m2 [adjusted OR 0.55, 95% CI 0.30-1.00, p = 0.051]; the < 18.5 kg/m2 subgroup showed a nonsignificant increase in risk: adjusted OR 1.41, 95% CI 0.84-2.35, p = 0.196), and oral feeding (vs. feeding tube as reference) (adjusted OR 2.27, 95% CI 1.07-4.76, p = 0.030). In non-nasopharyngeal cancer, radiotherapy interruption significantly reduced 5-year OS (14.3% vs. 29.9%, p = 0.03). Chemotherapy interruptions did not significantly affect survival.
CONCLUSIONS: Hypoalbuminemia (< 3.5 g/dL), pretreatment BMI category, and feeding route independently predict chemotherapy interruptions in HNC. Radiotherapy interruptions significantly impair survival in non-nasopharyngeal cancers. These readily available markers should guide pretreatment nutritional optimization and feeding tube consideration in high-risk patients.