Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.
尽管头颈癌治疗已取得进展，但几乎所有患者都会经历放化疗引起的毒性反应。口腔黏膜炎和吞咽困难是最常见的两种不良反应，对患者产生全身性影响，不仅阻碍治疗效果，还严重影响生活质量。准确预测重症病例对于改进管理策略并最终改善患者预后至关重要。本范围综述系统梳理了已报道的预测因子，并对这两种并发症预测模型的性能、方法学及报告质量进行了批判性评估。通过数据库检索共纳入174项研究，其中73项报告口腔黏膜炎预测因子，97项报告吞咽困难预测因子，4项同时报告两种预测因子。这些预测因子涵盖患者人口学特征、肿瘤分型、放化疗方案、危及器官辐射剂量、遗传因素及临床实验室检测结果。值得注意的是，许多研究仅进行单变量分析或局限于特定类型的预测因子。在纳入研究中，共报告了多种预测模型：8个急性口腔黏膜炎模型、5个急性吞咽困难模型及9个晚期吞咽困难模型。急性口腔黏膜炎、急性吞咽困难和晚期吞咽困难预测模型的受试者工作特征曲线下面积分别为0.65-0.81、0.60-0.82和0.70-0.85。研究发现了若干需要改进的领域，包括需要开展具有足够样本量的外部验证、进一步标准化预测因子和结局定义，以及提供更全面的报告以促进结果可复现性。
肿瘤(癌症)患者之家