Analysis of Risk Factors for Swallowing Dysfunction after Oral Cancer Surgery and Construction of Prediction Model

DI Lu; KANG Pei; FENG Rui; WEI Huiling; ZHAO Qianqian; YU Xiaoyu; ZHANG Xiaoyan

doi:10.3639/i.issn.2095-3097.2025.02.012

Abstract：Objective To investigate the risk factors for swallowing dysfunction after oral cancer surgery and construct a prediction model.Methods A total of 178 patients who had undergone oral cancer surgery and were admitted to Hebei Medical University Stomatology Hospital from June 2020 to December 2023 were selected by using a systematic random sampling method.178 patients were divided into 122 patients(modeling data)and 56 patients(validation data)using a random number table method in a ratio of 7∶3.Water swallow test was conducted to evaluate the patients'swallowing function after surgery.The patients'clinical data were collected for univariate analysis and multivariate Logistic regression analysis to screen risk factors for postoperative swallowing dysfunction after oral cancer surgery.A prediction model for swallowing dysfunction after oral cancer surgery was constructed,and its sensitivity and specificity were analyzed using ROC curves.Results In the modeling data,94 patients developed swallowing dysfunction after surgery,with an incidence rate of 77.05％.Tongue cancer(OR=3.216),mouth floor carcinoma(OR=3.418),tumor diameter ≥4 cm(OR=2.123),musculi suprahyoidei removed ≥50％(OR=4.702),skin flap repair(OR=2.121),and postoperative combined radiotherapy(OR=1.828)were risk factors for swallowing dysfunction after oral cancer surgery(P＜0.05).The prediction model constructed was P=ex/(1+ex),X=-3.144+1.168 × tongue cancer+1.229 × mouth floor carcinoma+0.753 × tumor diameter+1.548 × musculi suprahyoidei removed+0.752 × skin flap repair+0.603 × postoperative combined radiotherapy.The area under the ROC curve was 0.931(95％CI:0.891-0.971,P＜0.001).The sensitivity and specificity were 0.928 and 0.796.Hosmer-Lemeshow goodness-of-fit test showed x2=5.614,P=0.690,indicating that the regression model had a good level of fitting.Clinical validation showed that the accuracy of the prediction model was 0.839,and the Kappa value of the consistency test was 0.563.Conclusion The risk factors for swallowing dysfunction after oral cancer surgery include tumor location,tumor diameter,musculi suprahyoidei removed,skin flap repair,and postoperative radiotherapy.The prediction model constructed in this study has a high accuracy rate and has certain guiding significance for predicting swallowing dysfunction after oral cancer surgery.