Multivariate analysis of chemotherapy induced oral mucositis in patients with head and neck tumors

Abstract

Abstract:

ObjectiveTo investigate the influencing factors of chemotherapy induced oral mucositis （CIOM） in patients with head and neck tumors.MethodsThe clinical data of 98 patients with head and neck tumors treated in Nantong Tumor Hospital of Jiangsu Province from July 2017 to July 2021 were analyzed retrospectively. The patients were divided into CIOM group （n=82） and non-CIOM group （n=16） according to whether CIOM occurred after chemotherapy. The general clinical data of the two groups were compared, and the levels of serum cystatin C （Cys-C）, hypersensitive C-reactive protein （hs-CRP） and homocysteine （Hcy） before chemotherapy of the two groups were detected and compared. Multivariate logistic regression analysis was used to explore the influencing factors of CIOM.ResultsThere were statistically significant differences in body mass index （BMI）（χ²=6.44,P=0.011）, oral care （χ²=4.36,P=0.037）, smoking history （χ²=7.82,P=0.005）, oral pH value （χ²=26.16,P<0.001）, radiotherapy history （χ²=13.31,P<0.001）, chemotherapy regimen （χ²=4.53,P=0.033）, application of antibiotics （χ²=14.53,P<0.001） and application of oral mucosal protec-tive agents （χ²=12.85,P=0.001） between the CIOM group and non-CIOM group. The serum Cys-C [（1.43±0.36） mg/Lvs.（1.05±0.28） mg/L], hs-CRP [（19.64±2.05） μmol/Lvs.（13.49±1.55） μmol/L] and Hcy [（14.34±1.71） μmol/Lvs.（9.63±1.38） μmol/L] before chemotherapy of the CIOM group were significantly higher than those of the non-CIOM group, with statistically significant differences （t=3.88,P<0.001;t=11.38,P<0.001;t=10.36,P<0.001）. Multivariate logistic regression analysis showed that BMI<18.5 kg/m²（OR=1.66, 95%CI： 1.18-2.14,P=0.005）, poor oral care （OR=2.42, 95%CI： 1.70-4.36,P=0.013）, smoking history （OR=1.53, 95%CI： 1.25-2.28,P=0.003）, oral pH≤7 （OR=2.46, 95%CI： 1.48-4.06,P<0.001）, radiotherapy history （OR=2.04, 95%CI： 1.60-3.44,P<0.001）, chemotherapy regimen containing fluorouracil （5-FU）（OR=1.81, 95%CI： 1.36-2.83,P=0.006）, and increased Cys-C （OR=2.03, 95%CI： 1.40-3.02,P<0.001）, hs-CRP （OR=2.26, 95%CI： 1.64-3.19,P<0.001） and Hcy （OR=1.77, 95%CI： 1.27-2.53,P<0.001） before chemotherapy were independent risk factors for the occurrence of CIOM in patients with head and neck tumors, while the application of antibiotics （OR=0.76, 95%CI： 0.43-0.95,P<0.001） and oral mucosal protective agents （OR=0.58, 95%CI： 0.27-0.88,P<0.001） were independent protective factors for the occurrence of CIOM in patients with head and neck tumors.ConclusionBMI<18.5 kg/m², poor oral care, smoking history, oral pH≤7, radiotherapy history, chemotherapy regimen containing 5-FU, increased Cys-C, hs-CRP and Hcy before chemotherapy are independent risk factors of head and neck tumors patients complicated with CIOM, while the application of antibiotics and oral mucosal protective agents are independent protective factors.

Key words:Head and neck neoplasms,Drug therapy,Stomatitis

Chen Yi, Han Liang, Cai Li. Multivariate analysis of chemotherapy induced oral mucositis in patients with head and neck tumors[J]. Journal of International Oncology, 2022, 49(9): 521-525.

Figures/Tables3

临床特征	CIOM组（n=82）	无CIOM组（n=16）	χ²值	P值	临床特征	CIOM组（n=82）	无CIOM组（n=16）	χ²值	P值
性别					居住状态
男	48（58.54）	10（62.50）	0.09	0.768	非独居	74（90.24）	13（81.25）	0.37	0.542
女	34（41.46）	6（37.50）	0.09	0.768	独居	8（9.76）	3（18.75）	0.37	0.542
年龄（岁）					口腔pH值
<50	23（28.05）	5（31.25）	0.07	0.795	≤7	64（78.05）	2（12.50）	26.16	<0.001
≥50	59（71.95）	11（68.75）	0.07	0.795	>7	18（21.95）	14（87.50）	26.16	<0.001
BMI（kg/m²）					临床分期
<18.5	32（39.02）	1（6.25）	6.44	0.011	Ⅰ~Ⅱ期	19（23.17）	7（43.75）	1.95	0.163
≥18.5	50（60.98）	15（93.75）	6.44	0.011	Ⅲ~Ⅳ期	63（76.83）	9（56.25）	1.95	0.163
肿瘤类型					放疗史
鼻咽癌	26（31.71）	5（31.25）			有	51（62.20）	2（12.50）	13.31	<0.001
口腔癌	24（29.27）	4（25.00）			无	31（37.80）	14（87.50）	13.31	<0.001
下咽癌	17（20.73）	3（18.75）	0.42	0.981	慢性病史
喉癌	8（9.76）	2（12.50）			有	43（53.75）	7（43.75）	0.40	0.525
涎腺癌	7（8.54）	2（12.50）			无	39（48.75）	9（56.25）	0.40	0.525
口腔护理					化疗方案
良好	24（29.27）	9（56.25）	4.36	0.037	含5-FU	54（65.85）	6（37.50）	4.53	0.033
差	58（70.73）	7（43.75）	4.36	0.037	不含5-FU	28（34.15）	10（62.50）	4.53	0.033
吸烟史					抗生素应用
是	56（68.29）	5（31.25）	7.82	0.005	有	57（69.51）	3（18.75）	14.53	<0.001
否	26（31.71）	11（68.75）	7.82	0.005	无	25（30.49）	13（81.25）	14.53	<0.001
饮酒史					口腔黏膜保护剂应用
是	49（59.76）	12（75.00）	1.32	0.250	有	59（71.95）	4（25.00）	12.85	0.001
否	33（40.24）	4（25.00）	1.32	0.250	无	23（28.05）	12（75.00）	12.85	0.001

血清学指标	CIOM组（n=82）	无CIOM组（n=16）	t值	P值
Cys-C（mg/L）	1.43±0.36	1.05±0.28	3.88	<0.001
hs-CRP（μmol/L）	19.64±2.05	13.49±1.55	11.38	<0.001
Hcy（μmol/L）	14.34±1.71	9.63±1.38	10.36	<0.001

因素	Β值	SE值	Wald值	OR值	95%CI	P值
BMI（<18.5 kg/m²/≥18.5 kg/m²）	0.27	0.59	4.31	1.66	1.18~2.14	0.005
口腔护理（差/良好）	0.82	0.24	3.70	2.42	1.70~4.36	0.013
吸烟史（是/否）	0.41	0.37	4.53	1.53	1.25~2.28	0.003
口腔pH值（≤7/>7）	0.35	0.60	7.13	2.46	1.48~4.06	<0.001
放疗史（有/无）	0.44	0.62	5.49	2.04	1.60~3.44	<0.001
化疗方案（含5-FU/不含5-FU）	0.53	0.39	4.22	1.81	1.36~2.83	0.006
抗生素应用（无/有）	-0.31	-0.70	5.95	0.76	0.43~0.95	<0.001
口腔黏膜保护剂应用（无/有）	-0.72	-0.55	5.10	0.58	0.27~0.88	<0.001
化疗前Cys-C（原值录入）	0.58	0.44	6.01	2.03	1.40~3.02	<0.001
化疗前hs-CRP（原值录入）	0.36	0.51	7.12	2.26	1.64~3.19	<0.001
化疗前Hcy（原值录入）	0.30	0.72	6.49	1.77	1.27~2.53	<0.001

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