胃癌术后化疗患者化疗相关性味觉改变纵向变化轨迹及影响因素分析-现代医学

胃癌术后化疗患者化疗相关性味觉改变纵向变化轨迹及影响因素分析

单位：1. 南通巿肿瘤医院胃肠外科, 江苏南通 226006;
2. 南通巿肿瘤医院乳腺外科, 江苏南通 226006

分类号：R735

出版年·卷·期（页码）：2026·45·第四期（647-655）

摘要：

目的： 探讨胃癌术后化疗患者化疗相关性味觉改变纵向变化轨迹，并分析其影响因素。方法： 选取本院2021年6月至2024年1月胃癌术后化疗患者176例为研究对象，收集患者入院时临床资料，采用化疗相关性味觉改变量表(CiTAS)评估患者味觉改变情况，统计化疗前、化疗1个疗程、化疗2个疗程、化疗3个疗程后CiTAS评分，采用潜变量增长混合模型(LGMM)分析CiTAS轨迹的潜在类别，采用多元Logistic回归分析潜在类别的影响因素。结果： 176例患者脱落1例，剩余175例胃癌术后化疗患者化疗前、化疗1个疗程、化疗2个疗程、化疗3个疗程后CiTAS总分分别为(25.19±4.29)分、(38.25±7.36)分、(51.89±9.32)分、(61.43±8.45)分。线性趋势性检验显示，CiTAS评分整体呈现明显上升趋势(P＜0.001)。LGMM结果显示，3个类别时模型最优，分别设为快速上升组、缓慢上升组、基本平衡组，概率分别为0.543、0.274、0.183；3组年龄、含紫杉醇方案化疗、吸烟情况、口腔不良反应、焦虑/抑郁自评量表(SAS/SDS)评分、癌症疲乏量表(CFS)评分、营养不良风险比较，差异有统计学意义(P＜0.05)；以基本平衡组为对照，口腔不良反应、吸烟情况、CFS评分、含紫杉醇方案化疗为缓慢上升组的独立影响因素，口腔不良反应、吸烟情况、CFS评分、含紫杉醇方案化疗、年龄、营养不良风险、SAS评分、SDS评分为快速上升的独立影响因素(P＜0.05)。结论： 胃癌术后化疗患者味觉改变整体呈逐渐加重趋势，可分为快速上升、缓慢上升、基本平衡3种轨迹变化类型，口腔不良反应、吸烟情况、CFS评分、含紫杉醇方案化疗、年龄、营养不良风险、SAS评分、SDS评分为轨迹类别的影响因素，临床可据此制定针对性措施，以改善患者预后。

Objective: To explore the longitudinal trajectory of chemotherapy-related taste alterations in gastric cancer patients receiving postoperative chemotherapy and analyze its influencing factors. Methods: A total of 176 gastric cancer patients receiving postoperative chemotherapy in our hospital from June 2021 to January 2024 were enrolled. Clinical data of patients at admission were collected, and the Chemotherapy-induced Taste Alteration Scale(CiTAS) was used to assess taste alterations in patients. CiTAS scores were recorded before chemotherapy and after 1, 2, and 3 cycles of chemotherapy. Latent Growth Mixture Model(LGMM) was used to analyze the potential categories of CiTAS trajectory, and multivariate Logistic regression was used to analyze the influencing factors. Results: Among 176 patients, one patient dropped out, and the remaining 175 had CiTAS total scores of(25.19±4.29),(38.25±7.36),(51.89±9.32), and(61.43±8.45) at the four time points, respectively. Linear trend test showed that the CiTAS score showed a significant overall upward trend(P<0.001). LGMM results showed that the model was optimal with three categories, designated as rapid increase, slow increase, and basically stable groups, with probabilities of 0.543, 0.274, and 0.183, respectively. There were significant differences among the three groups in age, paclitaxel-containing regimen, smoking status, oral adverse reactions, Self-Rating Anxiety Scale/Self-Rating Depression Scale(SAS/SDS) scores, Cancer Fatigue Scale(CFS) scores, and malnutrition risk(P<0.05). With the basically stable group as control, oral adverse reactions, smoking status, CFS scores, and paclitaxel-containing regimen were independent influencing factors for slow increase group, while oral adverse reactions, smoking status, CFS scores, paclitaxel-containing regimen, age, malnutrition risk, SAS scores, and SDS scores were independent influencing factors for rapid increase group(P<0.05). Conclusion: Taste alterations in gastric cancer patients undergoing postoperative chemotherapy show an overall gradual worsening trend, with three trajectory categories: rapid increase, slow increase, and basically stable. Oral adverse reactions, smoking status, CFS score, paclitaxel-containing regimen, age, malnutrition risk, SAS score, and SDS score are influencing factors of trajectory categories. Targeted interventions should be formulated accordingly to improve patient prognosis.

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