- 學位論文
體重與存活率：一個簡單、理想且便利的晚期口腔癌預後因子
Body Weight and Survival: A Simple, Ideal and Convenient Prognostic Factor for Locally Advanced Oral Cavity Cancer
摘要
研究背景：癌症患者的營養支持議題，是癌症患者治療前、中、後，甚至追蹤期都會面臨的重要問題之一；營養不良的發生常與化學治療、放射線治療、及手術等治療選項有關，主要來自於治療所引起的副作用。尤其晚期口腔癌患者的標準治療準則是手術搭配術後輔助性的放射線治療（RT）或是同步化學放射線化療（CCRT），這些治療的副作用有很大的機會讓患者由口進食變得困難，進而導致營養狀況不佳、體重下降的情形發生。 研究目的：評估晚期口腔癌患者接受放射線治療過程中體重減輕（BWL）的情形，以及體重下降幅度對存活結果的影響。 研究材料與方法：本回溯性研究對象為台灣南部某醫學中心2010年1月1日至2017年12月31日期間，診斷為口腔鱗狀上皮細胞癌的20歲以上患者，並排除女性、唇癌、同時多原發頭頸癌、早期癌症（第一、二期）、多於一種癌症、未進行手術及病歷紀錄不完整的個案。體重下降（BWL）定義為接受RT或CCRT患者的第一週體重與療程中最低體重的差距，並以百分比（體重差 / 第一週體重）來呈現。整體存活率（OS）是本研究的主要觀察目標，次要目標為癌症存活率（CSS）和無病存活率（DFS）。 研究結果：總共有200名患者符合納入和排除條件。追蹤時間中位數為29個月，在此期間有74名患者（37％）死亡。在單變量分析中，病理中度風險因子（LVI、PNI）、病理高度風險因子（ENE、手術邊緣）、同步化學治療及體重下降超過10%在整體存活率（OS）、癌症存活率（CSS）和無病存活率（DFS）都顯著較差。而在Cox迴歸模型的多變量分析中，經過其餘6項因子的校正後，同步化學治療與體重下降大於10%仍然對整體存活率（OS）、癌症存活率（CSS）和無病存活率（DFS）皆有負面影響。體重下降超過10%的整體存活率（OS）風險比為2.93（95％CI: 1.08 – 7.93，p = 0.035）、癌症存活率（CSS）為3.76（95％CI: 1.33 – 10.6，p = 0.012）、無病存活率（DFS）則為3.47（95％CI: 1.41 – 8.55，p = 0.007）。 結論：晚期口腔癌患者接受術後輔助性放射線治療時，若治療期間體重下降超過10％以上，其存活相關風險顯著較差。放射線治療期間同步進行化學治療亦為顯著的不利預後因素。故在放射線治療過程中建議應考慮加強營養與心理支持以避免體重下降大於10%。
並列摘要
Background. Nutrition support is always one of the important issues that cancer patients will be facing during the whole treatment course, even before diagnosis or follow-up status. Malnutrition often occurred with chemotherapy, radiotherapy (RT), post-operative condition, mainly caused by the adverse effects of the treatment. Surgical intervention with adjuvant RT, or concurrent chemo-radiotherapy (CCRT), is the main treatment modality of the advanced stage of oral cavity cancer (OCC), which may cause huge insufficiency of oral intake, leading to unmet nutrition status. Purpose. The goal of this study is to evaluate the body weight loss (BWL) during radiation course, and the possible effect on survival outcome. Method. Patients aged over 20 years old with diagnosed squamous cell carcinoma (SCC) of the oral cavity between January 1st, 2010 and December 31st, 2017 in a single medical center were included in this retrospective study. Patients were excluded if they had the following characters of female, lip origin, a synchronous primary tumor in the head and neck region, exceed more than 1 malignant disease, early-stage (stage I and II), without the major operation of the primary site, or incomplete medical records. BWL was defined as the percentage of weight loss between patients’ first week of receiving RT or CCRT, and the minimum weight during the whole treatment course. The primary outcome of this study was overall survival (OS), and secondary outcomes were cancer-specific survival (CSS) and disease-free survival (DFS). Result. Totally, 200 patients met the inclusion and exclusion criteria. Median follow-up time was 29 months, which 74 patients (37%) died during this period. In univariate analysis, pathological intermediate-risk factor (lympho-vascular invasion [LVI], perineural invasion [PNI]), high-risk factor (extra-nodal extension [ENE], margin status), presenting concurrent chemotherapy, and BWL >10% had significantly poorer survival outcomes in OS, CSS, and DFS. After adjustment with the other six factors in the Cox proportional hazards model, BWL >10% and presenting concurrent chemotherapy still had negative effects on three survival outcomes. The hazard ratios of BWL in OS, CSS and DFS were 2.93 (95% CI: 1.08 – 7.93, p = 0.035), 3.76 (95% CI: 1.33 – 10.6, p = 0.012) and 3.47 (95% CI: 1.41 – 8.55, p = 0.007), respectively. Conclusion. Patients of advanced oral cavity cancer receiving post-operative adjuvant radiotherapy with BWL over 10% had poorer survival results. Presenting of concurrent chemotherapy was also an unfavorable prognostic factor. Intensive nutrition support should be considered during the radiation treatment course to avoid significant BWL.