老年头颈部鳞状细胞癌患者的治疗耐受性及预后情况分析

Treatment tolerance and prognosis in elderly patients with head and neck squamous cell carcinoma

目的探讨老年头颈部鳞状细胞癌(HNSCC)患者的治疗耐受性及预后情况。方法选取42例老年HNSCC患者,采用Cox比例风险回归模型分析其治疗耐受性和不良反应的影响因素,分析导致其治疗中断的根本原因,并对相关因素进行生存分析。结果不同临床症状老年HNSCC患者原发灶位置比较,差异均有统计学意义(P﹤0.05),其中喉癌患者发生疼痛、吞咽困难和口腔黏膜炎的风险最低(P﹤0.05);美国东部肿瘤协作组(ECOG)体力状况(PS)评分为3~4分患者发生疼痛和吞咽困难的风险较高,而发生口腔黏膜炎的风险较低(P﹤0.05);年龄校正的查尔森合并症指数(aCCI)评分﹥8分的患者发生吞咽困难的风险最高,口腔黏膜炎的风险最低(P﹤0.01);TNM分期为Ⅲ~Ⅳ期的患者发生疼痛、吞咽困难、口腔黏膜炎的风险均较高(P﹤0.05)。不同ECOG评分、原发灶位置、TNM分期、治疗方式的选择、治疗中断情况老年HNSCC患者伴或不伴合并症比较,差异均有统计学意义(P﹤0.05)。不同治疗中断情况老年HNSCC患者的PFS比较,差异有统计学意义(HR=2.406,95%CI:0.977~5.925,P=0.042);伴或不伴合并症老年HNSCC患者的PFS比较,差异无统计学意义(P﹥0.05)。结论伴有合并症的老年HNSCC患者具有更高的ECOG评分,晚期患者更容易发生各类严重合并症,导致治疗耐受性差,不良反应的发生风险增高,进一步导致治疗中断而造成预后不良。

Objective To explore the tolerance and prognosis of elderly patients with head and neck squamous cell carcinoma(HNSCC).Method A total of 42 elderly patients with HNSCC were selected.Cox proportional hazards re-gression model was used to analyze the influencing factors of treatment tolerance and adverse reactions,the root causes of treatment interruption,and the survival of related factors.Result There were significant differences in the different clinical symptoms location of primary focus in elderly patients with HNSCC(P<0.05).Among them,patients with laryn-geal cancer had the lowest risk of pain,dysphagia and oral mucositis(P<0.05).Patients with Eastern Cooperative Oncolo-gy Group(ECOG)performance status(PS)score of 3-4 had higher risk of pain and dysphagia,but lower risk of oral mu-cositis(P<0.05).Patients with an age adjusted Charlson comorbidity index(aCCI)score>8 had the highest risk of dys-phagia,and the risk of oral mucositis was the lowest(P<0.01).Patients with TNM stageⅢ-Ⅳhad higher risk of pain,dysphagia and oral mucositis(P<0.05).There were significant differences in different ECOG scores,location of primary focus,TNM stage,choice of treatment methods,interruption of treatment and elderly HNSCC patients with or without complications(P<0.05).There was significant difference in PFS among elderly HNSCC patients with different treatment interruptions(HR=2.406,95%CI:0.977-5.925,P=0.042).There was no significant difference in PFS between elderly HN-SCC patients with or without complications(P>0.05).Conclusion Elderly HNSCC patients with comorbidities have higher ECOG scores,and advanced HNSCC patients are more likely to develop various severe comorbidities.Elderly HN-SCC patients with severe complications have poor tolerance to the treatment and have a higher risk of adverse reactions,further leading to treatment interruption and poor prognosis.