【研究目的】探究口咽癌放疗后长期生存患者的症状负荷发生率及其严重情况，建立核心症状群，并探究其与生存质量之间的相关性。

【材料与方法】回顾性分析2010年1月至2020年12月期间中国医学科学院肿瘤医院接受放疗的口咽癌患者，2023年12月至2024年8月使用中文版安德森症状评估量表‐头颈部和欧洲癌症研究组织生存质量问卷对患者的症状负荷和生存质量进行评估。使用探索性因子分析（主成分分析法和最优斜交法）确定症状群的组成；Spearman相关分析用于探究各症状间的相关性以及症状群总体得分与生存质量各维度标准化得分之间的关系，并通过多元线性回归分析进一步明确研究症状群与总体生存质量之间的关系。此外，采用单因素分析和多因素分析探究各症状群的影响因素。

【研究结果】共纳入273例患者，中位随访时间为6.2年（范围为3.5~14.5年），随访时中位年龄为61岁（范围27~88岁）。患者报告的症状负荷发生率前五位分别为：口腔或咽喉黏液问题（147例，53.8%）、牙齿或牙龈问题（143例，52.4%）、口干（140例，51.3%）、吞咽或咀嚼困难（95例，34.8%）和味觉异常（79例，28.9%），其中最严重的症状是口干。各个症状间多具有相关性。症状困扰中发生率最高的是工作（包括家务）产生影响（55例，20.1%）。通过探索性因子分析共发现3个症状群，即口干‐睡眠症状群、进食‐发声症状群以及疲乏‐恶心症状群。其中，进食‐发声症状群在该患者队列中最为严重。上述3个症状群分别与生存质量的多个维度呈负相关，且均为患者的总体生存质量的危险因素（均P﹤0.01）。其中，疲乏‐恶心症状群对患者的生存质量影响最大。

【研究结论】口咽癌放疗后长期生存患者的症状负荷较重，口干‐睡眠症状群、进食‐发声症状群以及疲乏‐恶心症状群是影响生存质量的核心症状群。

Objective: To explore the occurrence and severity of symptom in long‐term survival patients with oropharyngeal cancer after radiotherapy, establish the symptom clusters and explore the correlation between them and quality of life.

Patients and methods: A retrospective cohort of patients with oropharyngeal cancer  who received radiotherapy at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2010 to December 2020 was established. This study analyzed the long-term survivors who were still alive until December 2023. The symptom burden and quality of life of long‐term survivors were evaluated using Chinese version of MDASI‐H&N and EORTC QLQ‐C30 from December 2023 to August 2024. Descriptive analysis, factor analysis and correlation analysis were used for statistical analysis. The symptom clusters were determined mainly by exploratory factor analysis (principal component analysis and Promax rotation). Spearman correlation analysis was used to explore the correlation between symptoms, and the relationship between the overall score of symptom clusters and the SS of each dimension of quality of life. Multiple linear regression analysis was used to further clarify the relationship between symptom groups and general quality of life. In addition, single factor analysis and multiple factor analysis were used to explore the influencing factors of each symptom cluster.

Results: 273 patients were included in total. The median follow-up time was 6.2 years (range, 3.5-14.5 years), and the median age at the time of follow-up was 61 years (range, 27-88 years). The top five incidence rates of symptom reported by patients were problem with mucus (147, 53.8%), problem with teeth or gum (143, 52.4%), dry mouth (140, 51.3%), difficulty swallowing or chewing (95, 34.8%), and problem with tasting food (79, 28.9%), among which dry mouth was the most serious symptom for patients. Most symptoms are correlated with each other. The highest incidence of symptom distress was work (55, 20.1%). Through exploratory factor analysis, three symptom clusters were found, namely, fatigue‐nausea symptom cluster, eating‐voice symptom cluster and dry mouth‐sleep symptom cluster，and the eating‐voice symptom cluster was the most severe one in this patient cohort, with the highest score of MDASI‐H&N. The above three symptom clusters are negatively correlated with multiple dimensions of quality of life, and negatively correlated with the general quality of life of patients (all P﹤0.01). And the fatigue‐nausea symptom cluster has the greatest impact on patients among them.

Conclusion: Patients with oropharyngeal cancer have heavy symptom burden in long-term survival after radiotherapy. Fatigue‐nausea symptom cluster, eating‐voice symptom cluster and dry mouth‐sleep symptom cluster are the core symptom clusters that affect the quality of life.