Supplementary Material for: Possible Clinical Predictors for Dysphagia in Head and Neck Cancer Patients after Surgery

Introduction. Dysphagia is one of the most frequent sequels of the head and neck cancer (HNC). For postoperative HNC patients, several clinical parameters such as wet voice are used in the dysphagia assessment. However, most of these parameters were validated for stroke and geriatric patients. Seven clinical parameters were scrutinized in the current study for HNC patients regarding quality criteria for the prediction of dysphagia.
Methods. Seven core clinical parameters (dysglossia, wet voice, abnormal volitional cough, reduced mouth opening, limited tongue motility and strength, gag reflex) and three combinations of such parameters were assessed in 184 postoperative HNC patients . The Penetration-aspiration scale and Functional Oral Intake Scale were phi-correlated and cross-tabulated with the clinical parameters for the analysis of their quality criteria. The predictive power of clinical parameters was assessed by three logistic regressions and three classification trees, with dysphagia, aspiration, and limitations of oral intake as dependent variables.
Results. All phi-correlations between clinical parameters and both scales were low to non-existent (ρ = .002 – .320). Sensitivity, specificity, positive likelihood ratio, and efficiency of clinical parameters and their combinations also yielded unsatisfactory results in the prediction of dysphagia. In regression analyses, wet voice showed a weak, but significant influence on the dysphagia, aspiration, and limitations of oral intake. In classification trees, none of clinical parameters yielded significant results.
Conclusion. Neither clinical parameters nor their combinations can predict dysphagia in HNC patients. No factors can be recommended for the clinical use. Water swallow tests should be used clinically because they demonstrated better quality criteria for this population in the previous research.

引言。吞咽障碍（dysphagia）是头颈部癌（head and neck cancer, HNC）最常见的后遗症之一。针对头颈部癌术后患者，临床常采用湿声等多项临床参数开展吞咽障碍评估。然而，此类参数大多仅针对脑卒中及老年患者完成了有效性验证。本研究针对头颈部癌患者，就7项临床参数用于吞咽障碍预测的质量标准展开了详细审视与评估。方法。本研究纳入184名头颈部癌术后患者，对7项核心临床参数（舌运动障碍（dysglossia）、湿声（wet voice）、自主咳嗽异常（abnormal volitional cough）、张口受限（reduced mouth opening）、舌活动度与力量下降（limited tongue motility and strength）、咽反射（gag reflex））以及3项参数组合方案开展评估。将渗透-误吸量表（Penetration-Aspiration Scale）与功能性口腔进食量表（Functional Oral Intake Scale）与临床参数进行φ相关（phi-correlated）分析与交叉制表，以解析其质量标准。采用3种逻辑回归（logistic regression）模型与3棵分类树（classification tree）评估临床参数的预测效能，以吞咽障碍、误吸及口腔进食受限作为因变量。结果。临床参数与两类量表间的所有φ相关系数均较低，甚至无相关性（ρ=0.002~0.320）。临床参数及其组合在预测吞咽障碍时，其灵敏度、特异度、阳性似然比及诊断效能均未达到理想水平。回归分析结果显示，湿声对吞咽障碍、误吸及口腔进食受限仅存在微弱但具有统计学意义的影响。分类树分析则未发现任何一项临床参数具备显著预测价值。结论。无论是单项临床参数还是其组合方案，均无法对头颈部癌患者的吞咽障碍进行有效预测，无任何因素可推荐用于临床实践。鉴于既往研究显示饮水吞咽试验针对该人群具备更优的质量标准，故临床应采用饮水吞咽试验开展相关评估。