头颈癌幸存者放疗后的疲乏——患病率、危险因素及与放射剂量的相关性
Fatigue in head and neck cancer survivors after radiotherapy - prevalence, risk factors, and radiation dose correlates.
文献信息
| PMID | 42900449 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Valentin Magnus |
| 作者单位 | Department of Radiation Oncology, University Medical Center Leipzig, Leipzig, Germany. |
| 期刊 | Journal of cancer survivorship : research and practice |
| SCI 分区 | Q1 |
| IF | 4.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 确定头颈癌幸存者中疲乏的患病率并识别相关因素，包括与脑部危及器官（OAR）放射剂量的潜在关联。
方法： 这项横断面观察性研究纳入2005年至2023年间在一家三级癌症中心接受根治性放疗的幸存者。使用EORTC QLQ-C30评估疲乏和健康相关生活质量（HRQoL）。剂量学分析评估疲乏与颅内OAR（脑干、小脑、后颅窝、延髓、垂体、基底节、海马）放射剂量之间的关联，包括基于体素的分析（VBA）。
结果： 共纳入158例患者。最常见的肿瘤部位为口咽（38.6%）。从放疗完成到参与研究的中位时间为41（IQR，22-61）个月。平均疲乏评分为44.7（SD，28.0），超过年龄和性别校正的德国一般人群疲乏水平（29.7）；51.3%的患者表现出临床相关疲乏（≥39分）。疲乏与HRQoL呈负相关（ρ = -0.59，p < 0.001），与痛苦呈正相关（ρ = 0.54，p < 0.001），与癌症复发恐惧呈正相关（ρ = 0.41，p < 0.001）。体能状态受损患者以及喉癌和下咽癌患者的疲乏更高。脑部OAR放射剂量和骨骼肌质量指数均与疲乏无关，VBA未显示相关亚区。
结论： 临床相关疲乏影响约半数头颈癌幸存者。
对癌症幸存者的意义： 与脑部OAR剂量缺乏相关性提示，其他可能为多因素的躯体、心理和生活方式相关因素在疲乏发生中比所研究的放疗相关脑部暴露发挥更核心的作用。
英文摘要
PURPOSE: To determine the prevalence of fatigue in head and neck cancer survivors and identify associated factors, including potential associations with radiation dose to cerebral organs at risk (OAR).
METHODS: This cross-sectional observational study included survivors treated with curative radiotherapy between 2005 and 2023 at a tertiary cancer center. Fatigue and health-related quality of life (HRQoL) were assessed with the EORTC QLQ-C30. Dosimetric analyses evaluated associations between fatigue and radiation dose to intracranial OAR (brainstem, cerebellum, posterior fossa, medulla, pituitary gland, basal ganglia, hippocampus), including voxel-based analysis (VBA).
RESULTS: One hundred fifty-eight patients were included. The most common tumor site was the oropharynx (38.6%). Median time from radiotherapy completion to study participation was 41 (IQR, 22-61) months. The mean fatigue score was 44.7 (SD, 28.0), exceeding the fatigue levels in the age- and sex-adjusted German general population (29.7); 51.3% of patients showed clinically relevant fatigue (≥ 39 points). Fatigue was inversely associated with HRQoL (ρ = - 0.59, p < 0.001), and positively with distress (ρ = 0.54, p < 0.001) and fear of cancer recurrence (ρ = 0.41, p < 0.001). Higher fatigue was found in patients with impaired performance status and in those with laryngeal and hypopharyngeal cancers. Neither cerebral OAR radiation doses nor skeletal muscle mass index was associated with fatigue, and VBA revealed no relevant subregions.
CONCLUSIONS: Clinically relevant fatigue affects about half of head and neck cancer survivors.
IMPLICATIONS FOR CANCER SURVIVORS: The absence of a correlation with cerebral OAR doses suggests that other, probably multifactorial somatic, psychological and lifestyle-related factors play a more central role in the genesis of fatigue than the radiation-related brain exposures investigated.