头颈部放疗后口腔健康参数恶化——来自多学科头颈部肿瘤委员会的前瞻性观察研究结果
Worsening of Oral Health Parameters After Head and Neck Radiotherapy-Findings from a Multidisciplinary Head and Neck Tumor Board: A Prospective Observational Study.
文献信息
| PMID | 42882905 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Cosimo Rupe |
| 作者单位 | Head and Neck Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy. |
| 期刊 | Cancers |
| SCI 分区 | Q2 |
| IF | 5.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 评估接受放疗（RT）和放化疗（RTCT）治疗头颈癌（HNC）的患者队列中（a）龋病经历的变化、（b）牙周状况的变化以及（c）拔牙需求。
方法： 本前瞻性队列研究经当地伦理委员会批准（编号22858/18），并在ClinicalTrials.gov注册（ID：NCT04009161）。研究人群为HNC患者，这些患者在RT前接受牙科检查并清除口腔感染灶，随后纳入随访计划。主要结局为口腔健康恶化，定义为发生重度牙周炎和/或DMFt评分≥13。通过勾画“颊黏膜”危及器官（OAR）获得口腔RT剂量。
结果： 共纳入113例患者（中位随访：44.77个月）。样本主要包括口腔癌、口咽癌、鼻咽癌和喉癌（89/113，78.8%）。唾液腺、下咽及其他部位占少数（24/113，21.2%）。17例患者（34.7%）随时间出现口腔健康状况恶化，且与吸烟相关（OR=4.7，95%CI：1.27-17.37；p=0.02）。DMFt指数升高（差值：4.08；95%CI：1.60-6.56；p=0.001），且该升高与吸烟相关（β=2.05，95%CI：0.27-3.83；p=0.02）。尽管牙周炎分期恶化无统计学意义（p=0.35），但观察到局部恶化，PPD≥5 mm的位点增加（p=0.02）。49例患者（43.4%）发生牙齿缺失。平均每例患者缺失2.12颗牙（p=0.05），主要原因为龋病（48.5%）和牙周炎（48.1%）。牙齿缺失的独立危险因素为年龄（p=0.025）和“颊黏膜”OAR的RT剂量>60 Gy（p=0.023）。
结论： 接受RT治疗的患者牙科和牙周健康出现显著恶化，口腔剂量学参数可能与牙齿缺失相关，但该关联尚需进一步研究确认。
英文摘要
OBJECTIVES: To evaluate (a) changes in caries experience, (b) changes in periodontal status, and (c) the need for dental extractions in a cohort of patients treated with radiotherapy (RT) and chemoradiotherapy (RTCT) for head and neck cancer (HNC).
METHODS: This prospective cohort study was approved by the local Ethics Committee (Ref. 22858/18) and registered at ClinicalTrials.gov (ID: NCT04009161). The study population consisted of patients with HNC who, prior to RT, underwent a dental examination followed by the elimination of oral foci of infection and were then enrolled in a follow-up program. The primary outcome was oral health worsening, defined as the onset of severe periodontitis and/or a DMFt score ≥ 13. Oral cavity RT dose was obtained contouring the 'buccal mucosa' organ at risk (OAR).
RESULTS: In total, 113 patients were included (median follow-up: 44.77 months). The sample mainly included oral, oropharyngeal, nasopharyngeal and laryngeal cancers (89/113, 78.8%). Salivary glands, hypopharynx and other sites accounted for a minority of the cases (24/113, 21.2%). Seventeen patients (34.7%) experienced worsening of oral health status over time, which was associated with smoking (OR = 4.7, 95% CI: 1.27-17.37; p = 0.02). The DMFt index increased (difference: 4.08; 95% CI: 1.60-6.56; p = 0.001), and this increase was associated with smoking (β = 2.05, 95% CI: 0.27-3.83; p = 0.02). Although worsening of periodontitis stage was not statistically significant (p = 0.35), localized deterioration was observed, with an increase in sites with PPD ≥ 5 mm (p = 0.02). Forty-nine patients (43.4%) experienced tooth loss. Mean tooth loss was 2.12 teeth per patient (p = 0.05), primarily due to caries (48.5%) and periodontitis (48.1%). Independent risk factors for tooth loss were age (p = 0.025) and an RT dose > 60 Gy to the 'buccal mucosa' OAR (p = 0.023).
CONCLUSIONS: Patients treated with RT experienced significant deterioration in dental and periodontal health, and oral cavity dosimetric parameters might be associated with tooth loss, although this association requires confirmation in further studies.