口腔癌患者における口腔機能障害は治療前から生じている可能性があり、早期の栄養改善が必要である。横断的研究

Oral Dysfunction in Patients with Oral Cancer Could Occur Before Treatment and Require Early Nutritional Improvement: A Cross-Sectional Study.

抄録

口腔癌患者は治療前の栄養状態が不良である。しかし、口腔扁平上皮癌（OSCC）患者の術前口腔機能を詳細に評価した報告はない。そこで、本研究では、OSCC 患者の術前口腔機能を評価し、栄養状態との関係を検討することを目的とした。2019年9月～2021年9月に島根大学医学部附属病院口腔外科を受診したOSCC患者51名（男性：37名、女性：14名、平均年齢：72.1歳）より口腔機能測定（微生物、口腔乾燥、咬合圧、咀嚼機能、EatingAssessment Tool、術後口腔障害尺度）およびミニ栄養評価-短冊（MNA-SF）データを収集した。原発性歯肉の部位は舌が最も多く［22名（43.1％）］、36名（70.6％）が進行がんであった。栄養状態と各関連因子を比較したところ、世帯人数、がんステージ、肺疾患の有無、歯数、微生物（グレード）、咀嚼機能（mg/dL）で有意差が認められた（p＜0.05）。MNA-SF の総得点を従属変数とし，交絡因子を調整した重回帰分析では，口腔乾燥と舌圧の間に有意な関連が認められた（p＜0.05）．Eating Assessment Tool，Postoperative Oral Dysfunction scaleについては，有意な関連はみられなかった．OSCC患者は診断時に腫瘍があるため、口腔機能が低下し、栄養状態が低下している可能性がある。口腔機能の状態に応じた栄養改善のための術前介入が必要である．

Patients with oral cancer have poor nutritional status before treatment. However, there have been no reports of the detailed evaluation of preoperative oral function in patients with oral squamous cell carcinoma (OSCC). Therefore, this study aimed to evaluate the preoperative oral function of patients with OSCC and examine the relationship with nutritional status. Oral function measurements (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, Eating Assessment Tool, and Postoperative Oral Dysfunction Scale) and Mini Nutritional Assessment-Short Form (MNA-SF) data were collected from 51 patients with OSCC (men: 37, women: 14, mean age: 72.1 years) who visited the Shimane University Hospital, Department of Oral and Maxillofacial Surgery, from September 2019 to September 2021. The tongue was the most prevalent primary gingiva site [22 patients (43.1%)], and 36 patients (70.6%) had advanced cancer. Comparisons between nutritional status and each related factor revealed significant differences in the number of individuals in the household, cancer stage, presence of pulmonary disease, number of teeth, microorganisms (grade), and masticatory function (mg/dL) (p < 0.05). Multiple regression analysis using the total MNA-SF score as the dependent variable with adjustment for confounding factors showed significant association between oral dryness and tongue pressure (p < 0.05). No significant association was found for the Eating Assessment Tool or Postoperative Oral Dysfunction scale. Patients with OSCC may have decreased oral function because of the tumor at the time of diagnosis, which causes a decline in nutritional status. Preoperative interventions are necessary to improve nutrition based on the state of oral function.