Systematic review of risk factors of postoperative dysphagia in patients with oral cancer

doi:10.7518/hxkq.2022.03.013

Abstract

Abstract: Objective

This study aims to identify risk factors of postoperative dysphagia in patients with oral cancer by systematic review.

Methods

Cohort studies in Chinese or English on risk factors of postoperative dysphagia in patients with oral cancer were searched from CNKI, Wanfang database, VIP Chinese Journal Database, China Biomedical Literature Service System, Chinese Clinical Trial Registry, PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials from the beginning to June 30, 2021. Subject words combined with free words were used to retrieve related articles. The included studies were evaluated, and the effective data were processed with Revman 5.3.

Results

Ten studies were selected, and they included 1 241 patients consisting of 473 patients in the exposed group and 768 patients in the control group. After the meta-analysis, the risk factors with statistical significance were as follows: age>60 years, tumor located in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy.

Conclusion

Age>60 years, tumor in oropharynx or mouth floor, tumor size of T3 or T4, TNM stage of Ⅳ, resection involving suprahyoid muscle or tongue resection>50%, combination of neck dissection, tracheotomy, or reconstruction, and postoperative radiotherapy were significant risk factors of postoperative dysphagia in patients with oral cancer.

Key words: oral cancer, dysphagia, risk factors, systematic review

CLC Number:

R 782

Lu Qian, Guo Liumei, Bi Xiaoqin. Systematic review of risk factors of postoperative dysphagia in patients with oral cancer[J]. West China Journal of Stomatology, 2022, 40(3): 328-334.

Figures/Tables 6

Fig 1

Tab 1

Tab 2

Fig 2

Fig 3

Fig 4

References 35

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第一作者及发表年份	国家	例数	评估时间	评估方法	结局指标	NOS得分情况
第一作者及发表年份	国家	例数	评估时间	评估方法	结局指标	选择	可比性	暴露	总分
Hasegawa T，2021^[16]	日本	64	术后1个月	吞咽能力评估量表	①③④	3	3	2	8
Huang ZS，2016^[17]	中国	112	术后3个月	吞咽造影检查	①⑤⑥	3	3	2	8
Klingelh?ffer C，2019^[18]	德国	400	术后第七天	纤维光学内窥镜检查	③④⑦⑧?	3	3	2	8
Miyamoto S，2012^[19]	日本	222	术后进食时	是否依赖胃肠营养管	①②⑥⑨⑩	2	2	2	6
Yamauchi T，2012^[20]	日本	75	出院时	是否依赖胃肠营养管	③⑥⑦⑧	2	2	2	6
Worley ML，2018^[21]	美国	66	术后6个月	功能性经口摄食量表	①③	4	2	2	8
Pezdirec M，2019^[22]	斯洛文尼亚	109	术后随访期间	头颈癌治疗后吞咽障碍问卷	②⑥??	3	2	1	6
Schache AG，2009^[23]	英国	31	术后4个月	功能性经口摄食量表	?	3	2	2	7
Fujimoto Y，2007^[24]	日本	62	术后6个月	口服摄入量及进食方式	①②⑧⑨	3	2	2	7
Smith JE，2008^[25]	美国	100	术后90 d内	改良钡剂试验	①??	3	1	2	6

危险因素	纳入研究数	异质性检验结果		效应模型	Meta分析结果
危险因素	纳入研究数	Q检验P值	I²	效应模型	OR（95%CI）	P值
年龄（>60岁）	2^[19,24]	0.84	0%	固定	2.65（1.38，5.09）	0.003
肿瘤生长部位（口咽、口底）	2^[22-23]	0.63	0%	固定	2.40（1.04，5.55）	0.04
肿瘤TNM分期（T3、T4）	4^{[16,18,20-21]}	0.71	0%	固定	4.64（2.93，7.34）	<0.000 01
肿瘤临床Ⅳ期	4^{[17,19-20,22]}	0.55	0%	固定	2.53（1.61，3.96）	<0.000 1
舌骨上肌切除或舌切除>50%	6^{[16-17,19,21,24-25]}	0.05	55%	随机	3.08（1.73，5.50）	0.000 1
行颈淋巴清扫术	2^[16,18]	0.57	0%	固定	2.76（1.55，4.93）	0.000 6
行气管切开术	2^[18,20]	0.45	0%	固定	2.55（1.46，4.43）	0.000 9
行修复重建术	3^[18,20,24]	0.62	0%	固定	6.69（3.15，14.21）	<0.000 01
术后联合放射性治疗	2^[19,24]	0.34	0%	固定	8.51（3.75，19.32）	<0.000 01

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