Background/Objectives: There is a varying need for nutritional support among head and neck cancer (HNC) patients. Unplanned hospitalization is frequent with definitive chemoradiation. However, the association of unplanned hospitalizations with cancer control outcomes and percutaneous endoscopic gastrostomy (PEG) tube placement is not well-understood. This study aims to evaluate the clinical outcomes stratified by unplanned hospitalizations and to identify the prognostic factors associated with unplanned hospitalizations. Methods: This retrospective cohort study included 657 HNC patients treated with definitive chemoradiation at a single institution between 2007 and 2023. Relevant clinical data were evaluated for unplanned hospitalizations, prophylactic vs. therapeutic PEG tube placement, and clinical outcomes. Multivariable, subgroup, and matched-pair analyses were performed to account for potential confounding variables. The main outcomes and measures used are overall survival (OS), progression-free survival (PFS), locoregional failure (LRF), distant failure (DF), and incidence of unplanned hospitalization. Results: Unplanned hospitalizations occurred in 190 (29%) patients, which were associated with worse OS (adjusted hazards ratio [aHR] of 2.07, 95% confidence interval [CI] of 1.53–2.81,p< 0.001) and progression-free survival (aHR 1.83, 95% CI 1.38–2.41,p< 0.001). However, hospitalizations were not associated with LRF or DF outcomes. Similar findings were noted on 180 matched pairs as well as subgroups stratified by p16 status. In addition, when compared to patients with a prophylactic PEG tube, therapeutic PEG tube placement was associated with a higher risk of hospitalization (adjusted odds ratio [aOR] of 1.96, 95% CI 1.10–3.54,p= 0.02), while those without PEG tubes were less likely to be hospitalized (aOR 0.48, 95% CI 0.27–0.86,p= 0.01). Conclusions: Unplanned hospitalization was an independent, adverse prognostic factor for poor survival, but not oncologic outcomes. Unplanned hospitalization incidence was largely driven by those who required a therapeutic PEG tube, while it was the lowest for those who never needed a PEG tube.
背景/目的：头颈癌患者对营养支持的需求存在差异。在接受根治性放化疗期间，非计划性住院情况频发。然而，非计划性住院与肿瘤控制结局及经皮内镜下胃造瘘术置管之间的关联尚未明确。本研究旨在评估按非计划性住院分层的临床结局，并识别与非计划性住院相关的预后因素。方法：本回顾性队列研究纳入了2007年至2023年间在同一机构接受根治性放化疗的657例头颈癌患者。收集相关临床数据以评估非计划性住院、预防性与治疗性胃造瘘管置入及临床结局。研究采用多变量分析、亚组分析和配对分析以控制潜在混杂因素。主要结局指标包括总生存期、无进展生存期、局部区域失败、远处转移及非计划性住院发生率。结果：190例（29%）患者发生非计划性住院，该现象与较差的总生存期（校正风险比2.07，95%置信区间1.53-2.81，p<0.001）和无进展生存期（校正风险比1.83，95%置信区间1.38-2.41，p<0.001）显著相关，但与局部区域失败或远处转移结局无显著关联。在180对配对病例及按p16状态分层的亚组分析中观察到相似结果。此外，与预防性胃造瘘置管患者相比，治疗性置管患者住院风险更高（校正比值比1.96，95%置信区间1.10-3.54，p=0.02），而未置管患者住院风险最低（校正比值比0.48，95%置信区间0.27-0.86，p=0.01）。结论：非计划性住院是生存预后不良的独立危险因素，但与肿瘤学结局无显著关联。非计划性住院主要发生于需要治疗性胃造瘘置管的患者群体，而从未需要置管的患者住院率最低。
肿瘤(癌症)患者之家