In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Patient Selection and Data Collection
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics between Survivors and Non-Survivors
3.2. Bleeding and Various Treatment Modalities
3.3. Univariate and Multivariate Logistic Regression Analyses of in-Hospital Mortality
3.4. Long-Term Mortality and Survival Analysis for Patients with Head and Neck Cancer (HNC) Bleeding
3.5. Recurrent Bleeding Assessment in HNC Patients
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Survivors N = 105 | Nonsurvivors N = 20 | p Value |
---|---|---|---|
Age (year) | 11.1 | 11.1 | 0.650 |
Male | 97 (92.4) | 17 (85.0) | 0.381 |
Systolic blood pressure (mmHg) | 34.3 | 40.8 | 0.917 |
Diastolic blood pressure (mmHg) | 17.7 | 19.8 | 0.457 |
Heart rate > 110 (beats/min) | 32 (30.5) | 9 (47.4) | 0.150 |
Smoking history | 79 (75.2) | 18 (90.0) | 0.240 |
Betel nut chewer | 69 (65.7) | 12 (60.0) | 0.624 |
Previous medical history | |||
Hypertension | 30 (28.6) | 8 (40.0) | 0.309 |
Diabetes mellitus | 18 (17.1) | 6 (30.0) | 0.216 |
Coronary artery disease | 5 (4.8) | 1 (5.0) | 1.000 |
Chronic kidney disease | 5 (4.7) | 1 (5.0) | 1.000 |
Other malignancy | 6 (5.7) | 2 (10.0) | 0.613 |
Prior stroke | 9 (8.6) | 0 (0) | 0.352 |
Liver cirrhosis | 10 (9.5) | 1 (5.0) | 1.000 |
Laboratory exam | |||
White cell count (103/uL) n = 123 | 7.9 | 5.9 | 0.784 |
Hemoglobin (g/dL) n = 124 | 2.2 | 1.8 | 0.189 |
Platelet count (103/uL) n = 123 | 102 | 159 | 0.322 |
INR n = 115 | 0.10 | 0.35 | 0.048 |
Creatinine (mg/dL) n = 123 | 0.94 | 1.84 | 0.278 |
ALT (U/L) n = 102 | 18.1 | 142 | 0.111 |
Variable | Survivors N = 105 | Non-Survivors N = 20 | p Value |
---|---|---|---|
Cancer site | 0.105 | ||
Oral cavity | 48 (45.7) | 7 (35.0) | |
Nasopharynx | 17 (16.2) | 3 (15.0) | |
Oropharynx | 22 (21.0) | 2 (10.0) | |
Hypopharynx | 14 (13.3) | 8 (40.0) | |
Larynx | 4 (3.8) | 0 (0) | |
T stage | 0.294 | ||
T ≤ 2 | 33 (31.4) | 3 (15.0) | |
T > 2 | 68 (64.8) | 16 (80.0) | |
Unknown | 4 (3.8) | 1 (5.0) | |
N stage | 0.656 | ||
N0 | 34 (32.4) | 6 (30.0) | |
N+ | 64 (61.0) | 14 (70.0) | |
Unknown | 7 (6.7) | 0 (0) | |
M stage | 0.157 | ||
M0 | 95 (90.5) | 16 (80.0) | |
M1 | 4 (3.8) | 3 (15.0) | |
Unknown | 6 (5.7) | 1 (5.0) | |
Pathology type | 0.745 | ||
Squamous cell carcinoma | |||
Keratinizing carcinoma | 96 (91.4) | 18 (90.0) | |
Non-keratinizing carcinoma | 7 (6.7) | 2 (10.0) | |
Sarcomatoid carcinoma | 1 (1.0) | 0 (0) | |
Adenocarcinoma | 1 (1.0) | 0 (0) | |
Initial cancer treatment | |||
Surgical resection | 51 (48.6) | 8 (40.0) | 0.482 |
Chemoradiation | 83 (79.0) | 17 (85.0) | 0.762 |
Neck dissection | 45 (42.9) | 7 (35.0) | 0.514 |
Flap reconstruction | 36 (34.3) | 7 (35.0) | 0.951 |
Local recurrence | 49 (46.7) | 9 (45.0) | 0.891 |
Bleeding cause | 0.268 | ||
Tumor related | 78 (74.3) | 18 (90.0) | |
Pseudoaneurysm | 19 (18.1) | 2 (10.0) | |
Post-operative complication | 8 (7.6) | 0 (0) | |
Bleeding type | 0.120 | ||
Self-limited | 40 (38.1) | 4 (20.0) | |
Active bleeding | 65 (61.9) | 16 (80.0) | |
Emergent CTA | 49 (46.7) | 13 (65.0) | 0.133 |
Bleeding treatment | 0.952 | ||
Supportive care | 77 (73.3) | 16 (80.0) | |
Embolization | 19 (18.1) | 4 (20) | |
Covered stent | 5 (4.8) | 0 (0) | |
Surgical ligation | 3 (2.9) | 0 (0) | |
Primary repair | 1 (1.0) | 0 (0) | |
Inotropic support | 3 (2.9) | 4 (20.0) | 0.013 |
Blood transfusion | 54 (51.4) | 11 (55.0) | 0.770 |
Univariate | Multivariate | |||
---|---|---|---|---|
OR (95%CI) | p Value | OR (95%CI) | p Value | |
Age | 0.99 (0.95, 1.03) | 0.647 | ||
Male | 0.47 (0.11, 1.94) | 0.295 | ||
Heart rate > 110 (beats/min) | 2.05 (0.76, 5.53) | 0.155 | ||
Inotropic support | 8.50 (1.74, 41.56) | 0.008 | 10.41 (1.81, 59.84) | 0.009 * |
Hypertension | 1.67 (0.62, 4.48) | 0.312 | ||
Diabetes mellitus | 2.07 (0.70, 6.12) | 0.187 | ||
Hypopharyngeal cancer | 4.33 (1.51, 12.47) | 0.007 | 4.32 (1.29, 14.46) | 0.018 * |
Surgical resection | 0.71 (0.27, 1.87) | 0.483 | ||
Chemoradiation | 1.50 (0.40, 5.59) | 0.544 | ||
Neck dissection | 0.72 (0.27, 1.95) | 0.515 | ||
Flap reconstruction | 1.03 (0.38, 2.82) | 0.951 | ||
T stage | 1.84 (1.01, 3.37) | 0.050 | 1.36 (0.70, 2.64) | 0.368 |
N stage | 1.05 (0.66, 1.68) | 0.827 | ||
M stage | 4.45 (0.91, 21.79) | 0.065 | 5.90 (1.07, 32.70) | 0.042 * |
Local recurrence | 0.94 (0.36, 2.44) | 0.891 |
Univariate | Multivariate | |||
---|---|---|---|---|
HR (95%CI) | p Value | HR (95%CI) | p Value | |
Age | 0.99 (0.97, 1.01) | 0.225 | ||
Male | 0.63 (0.30, 1.31) | 0.215 | ||
Heart rate > 110 (beats/min) | 1.95 (1.18, 3.23) | 0.010 | 2.02 (1.16, 3.51) | 0.013 * |
Inotropic support | 5.71 (2.40, 13.57) | <0.001 | 3.25 (1.20, 8.82) | 0.021 * |
Hypertension | 0.76 (0.44, 1.30) | 0.309 | ||
Diabetes mellitus | 1.02 (0.56, 1.07) | 0.943 | ||
Hypopharyngeal cancer | 2.79 (1.60, 4.85) | <0.001 | 2.22 (1.21, 4.06) | 0.010 * |
Surgical resection | 0.57 (0.35, 0.92) | 0.023 | 0.74 (0.42, 1.31) | 0.301 |
Chemoradiation | 2.55 (1.21, 5.37) | 0.014 | 2.10 (0.89, 4.94) | 0.094 |
Neck dissection | 0.76 (0.47, 1.23) | 0.260 | ||
Flap reconstruction | 0.88 (0.53, 1.45) | 0.603 | ||
T stage | 1.40 (1.10, 1.78) | 0.006 | 1.26 (0.96, 1.65) | 0.092 |
N stage | 1.33 (1.06, 1.68) | 0.015 | 1.19 (0.90, 1.58) | 0.213 |
M stage | 2.13 (0.76, 5.96) | 0.149 | ||
Local recurrence | 1.95 (1.20, 3.19) | 0.007 | 1.76 (0.99, 3.12) | 0.051 |
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Yen, C.-C.; Ho, C.-F.; Wu, C.-C.; Tsao, Y.-N.; Chaou, C.-H.; Chen, S.-Y.; Ng, C.-J.; Yeh, H. In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding. Medicina 2022, 58, 177. https://doi.org/10.3390/medicina58020177
Yen C-C, Ho C-F, Wu C-C, Tsao Y-N, Chaou C-H, Chen S-Y, Ng C-J, Yeh H. In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding. Medicina. 2022; 58(2):177. https://doi.org/10.3390/medicina58020177
Chicago/Turabian StyleYen, Chieh-Ching, Che-Fang Ho, Chia-Chien Wu, Yu-Ning Tsao, Chung-Hsien Chaou, Shou-Yen Chen, Chip-Jin Ng, and Heng Yeh. 2022. "In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding" Medicina 58, no. 2: 177. https://doi.org/10.3390/medicina58020177