Aims

Careful management of a patient's nutritional status during and after treatment for head and neck squamous cell cancers (HNSCC) is crucial for optimal outcomes. The aim of this study was to develop a model for stratifying a patient's risk of requiring reactive enteral feeding through a nasogastric tube during radiotherapy for HNSCC, based on clinical and treatment-related factors.

Materials and methods

A cohort of consecutive patients treated with definitive (chemo)radiotherapy for HNSCC between January 2016 and January 2018 was identified in the institutional electronic database for retrospective analysis. Patients requiring enteral feeding pretreatment were excluded. Clinical and treatment data were obtained from prospectively recorded electronic clinical notes and planning software.

Results

Baseline patient characteristics and tumour-related parameters were captured for 225 patients. Based on the results of the univariate analysis and using a stepwise backwards selection process, clinical and dosimetric variables were selected to optimise a clinically predictive multivariate model, fitted using logistic regression. The parameters found to affect the probability, P, of requiring a nasogastric feeding tube for >4 weeks in our clinical multivariate model were: tumour site, tumour stage (early T0/1/2 stage versus advanced T3/T4 stage), chemotherapy drug (none versus any drug) and mean dose to the contralateral parotid gland. A scoring model using the regression coefficients of the selected variables in the clinical multivariate model achieved an area under the curve (AUC) of 0.745 (95% confidence interval 0.678–0.812), indicating good discriminative performance. Internal validation of the model involved splitting the dataset 80:20 into training and test datasets 10 times and assessing differences in AUC of the model fitted to these.

Conclusions

We developed an easy-to-use prediction model based on both clinical and dosimetric parameters, which, once externally validated, can lead to more personalised treatment planning and inform clinical decision-making on the appropriateness of prophylactic versus reactive enteral feeding.

中文翻译：

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接受确定性（化疗）放疗的头颈癌患者反应性管饲的预测模型

宗旨

在头颈部鳞状细胞癌 (HNSCC) 治疗期间和之后仔细管理患者的营养状况对于获得最佳结果至关重要。本研究的目的是开发一个模型，根据临床和治疗相关因素，对 HNSCC 放疗期间需要通过鼻胃管进行反应性肠内喂养的患者风险进行分层。

材料和方法

在机构电子数据库中确定了 2016 年 1 月至 2018 年 1 月期间接受根治性（化学）放射治疗 HNSCC 的连续患者队列进行回顾性分析。排除需要肠内喂养预处理的患者。从前瞻性记录的电子临床记录和计划软件中获得临床和治疗数据。

结果

采集了 225 名患者的基线患者特征和肿瘤相关参数。基于单变量分析的结果并使用逐步向后选择过程，选择临床和剂量学变量以优化临床预测多变量模型，使用逻辑回归拟合。发现影响概率的参数，P，在我们的临床多变量模型中需要鼻胃管饲管超过 4 周的是：肿瘤部位、肿瘤分期（早期 T0/1/2 期与晚期 T3/T4 期）、化疗药物（无与任何药物相比）和平均剂量到对侧腮腺。使用临床多变量模型中所选变量的回归系数的评分模型实现了 0.745 的曲线下面积 (AUC)（95% 置信区间 0.678–0.812），表明具有良好的判别性能。模型的内部验证包括将数据集 80:20 分成 10 次训练和测试数据集，并评估拟合这些数据的模型的 AUC 差异。

结论

我们开发了一个基于临床和剂量学参数的易于使用的预测模型，一旦经过外部验证，就可以制定更加个性化的治疗计划，并为临床决策提供有关预防性和反应性肠内喂养适当性的信息。