Neil D Almeida, Han Yu, Austin J Iovoli, Mengyu Fang, Tyler V Schrand, Abigail Pepin, Vishal Gupta, Kimberly E Wooten, Michael R Markiewicz, Ryan P McSpadden, Wesley L Hicks, Mark K Farrugia, Anurag K Singh
{"title":"头颈部癌症化疗期间使用预防性胃造瘘管可减少体重下降，但会增加六个月后使用胃造瘘管的比例。","authors":"Neil D Almeida, Han Yu, Austin J Iovoli, Mengyu Fang, Tyler V Schrand, Abigail Pepin, Vishal Gupta, Kimberly E Wooten, Michael R Markiewicz, Ryan P McSpadden, Wesley L Hicks, Mark K Farrugia, Anurag K Singh","doi":"10.1016/j.oraloncology.2024.107136","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>The role of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement in head and neck cancer (HNC) patients treated with chemoradiation remains controversial and varies by center.</p><p><strong>Objective: </strong>To evaluate the impact of prophylactic PEG tube placement in patients undergoing chemoradiation for HNC PEG tube use for more than 6 months and weight loss.</p><p><strong>Design, setting, and participants: </strong>This single-institution retrospective study included 502 patients with head and neck cancer.</p><p><strong>Exposures: </strong>Concurrent Chemoradiation (CCRT) and prophylactic PEG tube placement.</p><p><strong>Main outcomes and measures: </strong>Univariate analyses were performed to determine risk factors for long term PEG tube and weight loss. Outcomes that were significantly associated with prophylactic PEG were selected for a multivariate analysis. The Kaplan-Meier method was used to estimate survival and the time to PEG removal, with comparisons between groups analyzed by log-rank tests. The global health status score from the EORTC QLQ30 was utilized to assess impact on quality of life.</p><p><strong>Results: </strong>Significantly higher weight loss was seen with the following variables: 1) omitting prophylactic PEG tube (p < 0.00001), 2) younger age (p = 0.0032), and 3) adjuvant CCRT (p = 0.0005). There was significantly higher risk of feeding tube duration longer than 6 months in those who: received prophylactic PEG tube (p < 0.0001) and were older than the median age of 60.8 years (p = 0.0165) on multivariate analysis. Prophylactic PEG tube was not associated with improved global health status, overall survival, or progression-free survival on univariate analysis.</p><p><strong>Conclusions and relevance: </strong>Prophylactic feeding tubes significantly decreased weight loss during treatment. Prophylactic PEG tube and older than median age was significantly associated with higher risk of feeding tube duration longer than 6 months.</p>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"160 ","pages":"107136"},"PeriodicalIF":4.0000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prophylactic gastrostomy tube during chemoradiation for head and neck cancer decreases weight loss but increases rate of tube use beyond six months.\",\"authors\":\"Neil D Almeida, Han Yu, Austin J Iovoli, Mengyu Fang, Tyler V Schrand, Abigail Pepin, Vishal Gupta, Kimberly E Wooten, Michael R Markiewicz, Ryan P McSpadden, Wesley L Hicks, Mark K Farrugia, Anurag K Singh\",\"doi\":\"10.1016/j.oraloncology.2024.107136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>The role of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement in head and neck cancer (HNC) patients treated with chemoradiation remains controversial and varies by center.</p><p><strong>Objective: </strong>To evaluate the impact of prophylactic PEG tube placement in patients undergoing chemoradiation for HNC PEG tube use for more than 6 months and weight loss.</p><p><strong>Design, setting, and participants: </strong>This single-institution retrospective study included 502 patients with head and neck cancer.</p><p><strong>Exposures: </strong>Concurrent Chemoradiation (CCRT) and prophylactic PEG tube placement.</p><p><strong>Main outcomes and measures: </strong>Univariate analyses were performed to determine risk factors for long term PEG tube and weight loss. Outcomes that were significantly associated with prophylactic PEG were selected for a multivariate analysis. The Kaplan-Meier method was used to estimate survival and the time to PEG removal, with comparisons between groups analyzed by log-rank tests. The global health status score from the EORTC QLQ30 was utilized to assess impact on quality of life.</p><p><strong>Results: </strong>Significantly higher weight loss was seen with the following variables: 1) omitting prophylactic PEG tube (p < 0.00001), 2) younger age (p = 0.0032), and 3) adjuvant CCRT (p = 0.0005). There was significantly higher risk of feeding tube duration longer than 6 months in those who: received prophylactic PEG tube (p < 0.0001) and were older than the median age of 60.8 years (p = 0.0165) on multivariate analysis. Prophylactic PEG tube was not associated with improved global health status, overall survival, or progression-free survival on univariate analysis.</p><p><strong>Conclusions and relevance: </strong>Prophylactic feeding tubes significantly decreased weight loss during treatment. Prophylactic PEG tube and older than median age was significantly associated with higher risk of feeding tube duration longer than 6 months.</p>\",\"PeriodicalId\":19716,\"journal\":{\"name\":\"Oral oncology\",\"volume\":\"160 \",\"pages\":\"107136\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-12-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Oral oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.oraloncology.2024.107136\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.oraloncology.2024.107136","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Prophylactic gastrostomy tube during chemoradiation for head and neck cancer decreases weight loss but increases rate of tube use beyond six months.
Importance: The role of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement in head and neck cancer (HNC) patients treated with chemoradiation remains controversial and varies by center.
Objective: To evaluate the impact of prophylactic PEG tube placement in patients undergoing chemoradiation for HNC PEG tube use for more than 6 months and weight loss.
Design, setting, and participants: This single-institution retrospective study included 502 patients with head and neck cancer.
Exposures: Concurrent Chemoradiation (CCRT) and prophylactic PEG tube placement.
Main outcomes and measures: Univariate analyses were performed to determine risk factors for long term PEG tube and weight loss. Outcomes that were significantly associated with prophylactic PEG were selected for a multivariate analysis. The Kaplan-Meier method was used to estimate survival and the time to PEG removal, with comparisons between groups analyzed by log-rank tests. The global health status score from the EORTC QLQ30 was utilized to assess impact on quality of life.
Results: Significantly higher weight loss was seen with the following variables: 1) omitting prophylactic PEG tube (p < 0.00001), 2) younger age (p = 0.0032), and 3) adjuvant CCRT (p = 0.0005). There was significantly higher risk of feeding tube duration longer than 6 months in those who: received prophylactic PEG tube (p < 0.0001) and were older than the median age of 60.8 years (p = 0.0165) on multivariate analysis. Prophylactic PEG tube was not associated with improved global health status, overall survival, or progression-free survival on univariate analysis.
Conclusions and relevance: Prophylactic feeding tubes significantly decreased weight loss during treatment. Prophylactic PEG tube and older than median age was significantly associated with higher risk of feeding tube duration longer than 6 months.
期刊介绍：
Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck.
Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.
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