Einfluss von Dysphagie- und ernährungsabhängigen Faktoren auf das Überleben von Patienten mit Larynx- und Hypopharynxkarzinomen

BACKGROUND AND OBJECTIVE: In addition to cancer-related survival, significant non-cancer-related modifiable risk factors are increasingly recognized in head and neck cancer due to disease localization and oncological therapy. Dysphagia in particular has an impact on overall survival, especially due to consequences such as aspiration pneumonia and malnutrition. This study aimed to assess these risks and possible influencing factors in a typical patient population of a German head and neck cancer center. METHODS: Patients with hypopharyngeal and laryngeal cancer were examined as part of a retrospective cohort study. Uni- and multivariable logistic regression was used to investigate the influence of independent variables on dysphagia- and diet-dependent outcome variables. Factors influencing survival were identified using Kaplan-Meier curves and Cox regression analysis. RESULTS: Pretherapeutic underweight (hazard ratio, HR, 2.025) and pneumonia (HR 1.569) were identified as significant risk factors for survival in 214 patients. At the same time, pretherapeutic underweight was found to be an influencing factor for pretherapeutic dysphagia (OR 7.6), which, in turn, was an influencing factor for posttherapeutic dysphagia (odds ratio, OR, 12.1). The presence of pre- and posttherapeutic dysphagia had a significant influence (OR 4.0) on the development of pneumonia. CONCLUSION: The results indicate that early and consistent treatment of malnutrition and dysphagia could improve long-term survival. Further studies on interventions addressing these influencing and risk factors are necessary to extend the outcome evaluation of pretreatment, early, and inpatient rehabilitation measures after oncological therapy beyond solely subjective patient-centered outcome measures. These future investigations should also address the consequences of dysphagia on disease management, quality of life, morbidity, and mortality as well as the costs associated with its complications.