A Meta Analysis On Risk Factors Of Radioactive Oral Mucositis In Patients With Head And Neck Malignancy

Objective: Head and neck malignancy has a high morbidity and mortality,the major treatment are operation and radiotherapy,supplemented by chemotherapy,targeted therapy,etc.Although the survival rate of patients with head and neck malignancy is improved after radiotherapy,the incidence and severity of various acute and chronic oral complications are also increased.Incidence of radioactive oral mucositis in patients accepting radiotherapy is close to 100%.Dysphagia,eating less and weight loss can be caused by severe oral pain in patients,will cause more frequent and longer hospitalization,more nutritional support,analgesia and nursing,etc.At present We haven’t found a very effective therapeutic method,there is also dispute about the discussion of risk factors.This study conducted a Meta-analysis on risk factors for radioactive oral mucositis in head and neck malignancy,so as to provide evidence-based proof for the prevention of radioactive oral mucositis in the clinical work,to help clinicians prevent and treat radioactive oral mucositis.Methods: Pub Med,Embase,Cochrane Library,CNKI,VIP and Wanfang were used to search literature related to risk factors of radioactive oral mucositis in the course of radiotherapy for patients with head and neck malignancy from the establishment of each database to December 2021.According to PECOS principles,the two researchers defined the research theme,designed the retrieval strategy and retrieved the literature,formulated inclusion and exclusion criteria,conducted literature screening according to the criteria,adopted the NOS(Newcastle-Ottawa Scale)to evaluate the literature quality,and extracted data from the finally included literature.Meta-analysis was completed by employing Rev Man 5.3 and Stata 12.0software.OR(Odds Ratio)and 95% CI(Confidence Interval)were calculated.The sensitivity analysis was performed by comparing the results of fixed effect model and random effect model and using trim and fill method.The publication bias and the stability of the results were evaluated by drawing funnel plot and Egger’s test.Results: After literature retrieval and screening,5 English literature and9 Chinese literature were included in this study,with a total sample size of3668 cases,including 2361 cases in the case group and 1307 cases in the control group.Meta-analysis showed that combining chemotherapy(OR=2.24,95%CI:1.66-3.02),smoking(OR=2.12,95%CI:1.45-3.10),drinking alcohol(OR=1.58,95%CI:1.09-2.29),diabetes mellitus(OR=1.99,95%CI:1.46-2.70),oral PH≤7(OR=3.11,95%CI:2.13-4.55),poor oral hygiene(OR=4.38,95%CI: 2.19-8.73),no antibiotics(OR=5.92,95%CI: 2.91-12.04)and no mucosal protective agent(OR=5.39,95%CI: 2.89-10.04)were risk factors for radioactive oral mucositis in patients with head and neck malignancy,and the differences were statistically significant(P<0.05).However,male and sticky saliva were not risk factors for radioactive oral mucositis in patients with head and neck malignancy,and the difference was not statistically significant(P>0.05).Results of Egger’s test show,combining chemotherapy,smoking,drinking alcohol,oral PH≤7,poor oral hygiene,no antibiotic,male and sticky saliva don’t have apparent publication bias,the results are stable.Conclusion: Combining chemotherapy,smoking,drinking alcohol,diabetes mellitus,oral PH≤7,poor oral hygiene,no antibiotics,no mucosa protectant are risk factors of radioactive oral mucositis in head and neck malignancy,the medical staff in the clinical work may take appropriate preventive measures to reduce the incidence and severity of radioactive oral mucositis.