Anthony T, Jones C, Antoine J, Sivess-Franks S, Turnage R
Department of Surgery, The University of Texas Southwestern Medical Center, Dallas 75235-9161, USA.
Ann Surg Oncol. 2001 Jan-Feb;8(1):44-9. doi: 10.1007/s10434-001-0044-2.
Little information is available on the impact that therapies used in the treatment of colorectal cancer (CRC) have on long-term, health-related quality of life (HRQL). Knowledge of how HRQL is affected by these therapies is essential in properly selecting patients for treatment. The purpose of this study was to determine the long-term impact that surgical and adjuvant therapy for resectable CRC has on patient-reported HRQL in a male veteran population through a case-control design.
All participating patients had completed therapy at least 6 months before enrollment. One hundred fifty-eight patients were accrued over a 3-year period (January 1, 1997 to December 31, 1999) at a single institution. The impact of CRC surgery on HRQL was measured by comparing a cohort of 61 patients undergoing surgery alone for the treatment of CRC (CRC-S group) with 44 patients undergoing surgery for benign colonic disease (BCD group). To study the effect of adjuvant therapy for CRC on HRQL, a third cohort of 53 patients undergoing both surgical and adjuvant treatment (CRC-S/A group) was compared with the CRC-S group. For each group, health status was measured by a health survey questionnaire, SHORT FORM 36 (SF36). For patients treated for CRC, an additional disease-specific supplemental questionnaire also was used.
Self-reported health status, as measured by mean SF36 score, was significantly reduced for the BCD group compared with CRC-S patients on general health perception (41.9 +/- 3.9 vs. 52.2 +/- 3.0, P = .04) and the standardized physical component score (31.2 +/- 1.7 vs. 37.5 +/- 1.5, P < .005). Despite an increased number of distally located tumors, later stage cancers, and an increased number of recurrences in the CRC-S/A group compared with the CRC-S cohort, no significant differences were identified between these groups on any of the subscales or standardized scores of SF36. Using the supplemental questions, no differences were identified between the CRC groups with respect to appetite, weight, or gastrointestinal or urinary functioning.
Surgical therapy for CRC probably has minimal impact on long-term HRQL when compared with surgery for benign colonic processes. Similarly, there does not appear to be a measurable, lasting impact of CRC adjuvant therapy on HRQL when compared with surgery alone. Although overall impact of therapies for CRC on HRQL appears to be limited, measurement of therapeutic influence on an individual level and identification of selection criteria based on estimated impact on HRQL for these therapies requires prospective validation.
关于用于治疗结直肠癌（CRC）的疗法对长期健康相关生活质量（HRQL）的影响，目前可用信息较少。了解这些疗法如何影响HRQL对于正确选择治疗患者至关重要。本研究的目的是通过病例对照设计，确定可切除CRC的手术和辅助治疗对男性退伍军人患者报告的HRQL的长期影响。
所有参与患者在入组前至少已完成治疗6个月。在3年期间（1997年1月1日至1999年12月31日），在单一机构招募了158名患者。通过比较61名单独接受CRC手术治疗的患者队列（CRC-S组）和44名接受良性结肠疾病手术治疗的患者（BCD组），来衡量CRC手术对HRQL的影响。为了研究CRC辅助治疗对HRQL的影响，将第三组53名接受手术和辅助治疗的患者（CRC-S/A组）与CRC-S组进行比较。对于每组，通过健康调查问卷简表36（SF36）来测量健康状况。对于接受CRC治疗的患者，还使用了一份额外的疾病特异性补充问卷。
通过平均SF36评分衡量，BCD组自我报告的健康状况在总体健康感知方面（41.9±3.9对52.2±3.0，P = 0.04）和标准化身体成分评分方面（31.2±1.7对37.5±1.5，P < 0.005）与CRC-S患者相比显著降低。尽管CRC-S/A组与CRC-S队列相比，远端肿瘤数量增加、癌症分期较晚且复发数量增加，但在SF36的任何子量表或标准化评分上，这些组之间均未发现显著差异。使用补充问题，CRC组在食欲、体重或胃肠道或泌尿功能方面未发现差异。
与良性结肠疾病手术相比，CRC手术治疗可能对长期HRQL影响最小。同样，与单独手术相比，CRC辅助治疗似乎对HRQL没有可测量的持久影响。尽管CRC治疗对HRQL的总体影响似乎有限，但对个体水平上治疗影响的测量以及基于这些疗法对HRQL的估计影响确定选择标准需要前瞻性验证。
