COVID-19時期的頭頸癌觀察性研究：單中心中斷時間序列分析

Abstract

背景：COVID-19疫情影響了全球的醫療系統，影響了各種疾病的診斷和治療，包括頭頸癌（HNC）。本研究通過單一中心的中斷時間序列分析，評估疫情對HNC臨床結果和死亡率的影響。 方法：我們分析了在亞東醫院接受治療的頭頸癌（HNC）患者的臨床數據，比較了疫情前後的時期。關鍵指標包括臨床分期、患者行為、生存率和死亡結果。我們使用了中斷時間序列分析和存活分析方法。該研究包括在2017年1月至2022年12月之間診斷的HNC患者。。 結果：本研究共納入1445位案例，其中疫情前期共749例，疫情期間共696例。研究發現在疫情前後，頭頸癌（HNC）分期存在顯著差異（0期：1.5% vs. 0%；IV期：49% vs. 43%；整體p=0.006）。患者飲酒行為在疫情期間減少（36% vs. 45%，p<0.001）。單變量生存分析發現兩個期間的整體生存率沒有顯著差異，但多變量分析顯示在疫情期間整體存活率呈下降趨勢（HR=1.20，95% CI：0.69-2.11，p=0.5）。中斷時間序列分析顯示，在疫情初期，每月死亡率最初有上升，隨後出現下降。此外，反事實模型預測在沒有COVID-19的情況下，每月死亡率顯著低於疫情早期和中期的實際死亡率，特別是在晚期（III/IV期）患者中（p=0.038），突顯了醫療服務中斷的負面影響。 結論：COVID-19大流行顯著影響了頭頸癌（HNC）的臨床結果，HNC的分期趨勢向更晚期發展。在疫情初期，每月死亡率初步上升，並預測在沒有疫情的情況下，每月死亡率將顯著降低，特別是對於晚期疾病。這些發現強調了在公共衛生危機期間，需要建立強大的醫療系統，以維持基本服務的重要性。

Background The COVID-19 pandemic has disrupted healthcare systems worldwide, affecting the diagnosis and treatment of various diseases, including head and neck cancer (HNC). This study evaluates the pandemic's impact on HNC clinical outcomes and mortality rates through a single-center interrupted time series analysis. Methods We analyzed clinical data from HNC patients treated at our center, comparing pre-pandemic and pandemic periods. Key metrics included staging, patient behaviors, survival rates, and mortality outcomes. We employed interrupted time series analysis and survival analysis methods. The study included patients diagnosed with HNC between January 2017 and December 2022. The following HNCs were included in this study: lip (ICD-10 code C00), tongue (ICD-10 codes C01, C02), gum (ICD-10 code C03), oral cavity (ICD-10 codes C04, C06) , palate (ICD-10 code C05), salivary glands (ICD-10 code C08), pharynx (ICD-10 codes C10-C14), and larynx (ICD-10 code C32) [37]. Results A total of 1445 cases were included in the study, 749 in the pre-pandemic period and 696 in the pandemic period. The study observed a significant difference in HNC stages between the pre- and post-pandemic periods (Stage 0: 1.5% vs. null; stage IV: 49% vs. 43%; overall p=0.006). Alcohol consumption among patients decreased during the pandemic (36% vs. 45%, p<0.001). Univariate survival analysis found no significant difference in overall survival between periods, though multivariate analysis indicated a trend towards lower overall survival during the pandemic (HR=1.2, 95% CI: 0.69-2.11, p=0.5). The interrupted time series analysis revealed an initial increase in monthly mortality rates early in the pandemic, with a subsequent decline. In addition, the counterfactual model predicted significantly lower monthly mortality rates in the absence of COIVD-19 than the actual rates in the early and mid-pandemic periods, especially among advanced stage (III/IV) patients (p=0.038)., highlighting the adverse impact of healthcare disruptions. Conclusion The COVID-19 pandemic significantly affected HNC clinical outcomes, with a shifting trend in HNC stages towards more advanced ones, initial increase in monthly mortality rates in the early pandemic period and predicted significantly lower monthly mortality rates in the absence of the pandemic, particularly for advanced-stage disease. These findings emphasize the need for robust healthcare systems capable of maintaining essential services during public health crises.