口腔鳞状细胞癌患者营养不良与cddp所致肾毒性的关系

IF 0.4 Q4 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery Medicine and Pathology Pub Date : 2025-02-25 DOI:10.1016/j.ajoms.2025.02.014

Yasuyuki Asada, Nanako Ito, Fumitaka Obayashi, Mirai Higaki, Atsuko Hamada, Sachiko Yamasaki, Koichi Koizumi, Souichi Yanamoto

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引用次数: 0

摘要

目的顺铂（CDDP）是口腔鳞状细胞癌（OSCC）药物治疗的关键药物，可引起急性肾损伤（AKI）。危险因素包括合并症，如高血压、CDDP剂量、年龄和低白蛋白血症；然而，目前对这些危险因素还没有达成共识。本研究通过研究高剂量CDDP治疗的OSCC患者的临床特征，包括营养状况和预后，以评估AKI的危险因素。方法选取22例经高剂量CDDP治疗术后高危复发的OSCC患者，分为治疗后发生AKI组（AKI）和未发生AKI组（non-AKI）。结果营养不良是AKI的独立危险因素。在受者工作特征曲线上计算的总CDDP剂量临界值为160.0 mg/m2。多因素分析显示营养不良(优势比，OR 12.5；95 %置信区间，CI 1.41-298.2；p = 0.02)，CDDP总剂量≥ 160 mg/m2 (OR 11.6, 95 % CI 1.17-295.9；p = 0.04)是AKI发生的独立且具有统计学意义的危险因素。治疗6个月后，AKI组和非AKI组血清肌酐水平均显著升高，AKI组慢性肾脏疾病（CKD）发生率呈上升趋势。AKI组的生存率明显低于非AKI组。结论OSCC患者易出现营养不良，口服摄入困难，使用CDDP后AKI发生风险高。此外，AKI的存在降低了生存率。

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Relationship between undernutrition and CDDP-induced nephrotoxicity in oral squamous cell carcinoma

Objectives

Cisplatin (CDDP), a key drug for oral squamous cell carcinoma (OSCC) pharmacotherapy, causes acute kidney injury (AKI). Risk factors include comorbidities such as hypertension, CDDP dose, age, and hypoalbuminemia; however, currently there is no consensus on these risk factors. This study investigated the clinical characteristics, including nutritional status, and prognosis of OSCC patients treated with high-dose CDDP to evaluate the risk factors for AKI.

Methods

A total of 22 OSCC patients treated with high-dose CDDP for high-risk postoperative recurrence were included and divided into two groups—those who developed AKI after treatment (AKI) and those who did not (non-AKI).

Results

Undernutrition was an independent risk factor for AKI. The cut-off value for the total CDDP dose calculated on the receiver operating characteristic curve was 160.0 mg/m². Multivariate analysis showed that undernutrition (Odds Ratio, OR 12.5; 95 % Confidence Interval, CI 1.41–298.2; p = 0.02) and total CDDP dose ≥ 160 mg/m² (OR 11.6, 95 % CI 1.17–295.9; p = 0.04) were independent and statistically significant risk factors for the development of AKI. After 6 months of treatment, serum creatinine levels markedly increased in both the AKI and non-AKI groups, and a trend towards higher incidence of chronic kidney disease (CKD) was observed in the AKI group. The survival rate was significantly lower in the AKI group than in the non-AKI group.

Conclusion

Patients with OSCC are prone to low nutrition owing to difficulties in oral intake, and the risk of AKI is high when CDDP is used. Furthermore, the presence of AKI reduces survival rate.

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