Pourel Nicolas, Peiffert Didier, Lartigau Eric, Desandes Emmanuel, Luporsi Elisabeth, Conroy Thierry
Department of Radiation Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):742-51. doi: 10.1016/s0360-3016(02)02959-0.
To collect data on the health-related quality of life (QOL) of long-term survivors and to determine to what extent QOL might be an appropriate end point in the comparison of treatment options in oropharyngeal carcinoma.
All patients treated between 1992 and 1998, in two French comprehensive cancer centers, by brachytherapy (BT) +/- external beam radiotherapy (EBRT) or surgery plus RT, or exclusive EBRT for T1-T3 (International Union Against Cancer staging system) oropharynx squamous cell carcinoma, were included. QOL was measured once in disease-free patients at least 2 years after treatment initiation. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific H&N35 module were self-administered by all participating patients. Sociodemographic data were collected using a questionnaire specifically designed for the study. The association between the QOL scores of the various treatment-, disease-, and patient-related variables was performed through bivariate analysis and then by multivariate analysis. The mean QOL scores of the EORTC QLQ-C30 questionnaire were compared with the mean scores in the general population.
Of the 159 eligible patients, 113 agreed to participate (97 men and 16 women, median age 61 years, range 41-83). The initial treatment was EBRT plus BT in 49 patients, surgery plus RT in 27, and EBRT alone in 37. The median follow-up time was 62 months (range 24-110). Compared with the general population, the three scores indicating the most impaired QOL were emotional and social functioning and fatigue. The clinical significance of global QOL impairment was borderline. The physical functioning, role functioning, and pain scores did not significantly differ from those of the general population. In multivariate analysis, the initial treatment had no significant influence on any dimension of QOL, except global QOL and emotional functioning. Surprisingly, surgery plus RT, as the initial treatment, favorably influenced the emotional functioning score and EBRT plus BT negatively influenced the global QOL score. None of these treatment modalities influenced any symptom scales. Patient selection was, at least partially, responsible for these paradoxical results.
The results of this study bring original and useful data about the QOL of long-term survivors of oropharynx carcinoma. In these patients, the QOL was significantly impaired, particularly in its psychosocial dimensions. The level of symptoms and functioning (except global QOL and emotional) was similar whatever the initial treatment. These results suggest the importance of coping processes. In a trial comparing treatment options from a long-term perspective, survival remains the most relevant end point, and a QOL evaluation should be a secondary end point. More prospective studies on QOL in head-and-neck cancer patients are needed to determine new strategies for rehabilitation management.
收集长期生存者与健康相关的生活质量（QOL）数据，并确定QOL在口咽癌治疗方案比较中作为合适终点的程度。
纳入1992年至1998年期间在法国两个综合癌症中心接受治疗的所有患者，这些患者因T1 - T3期（国际抗癌联盟分期系统）口咽鳞状细胞癌接受近距离放疗（BT）+/-外照射放疗（EBRT）或手术加放疗，或单纯EBRT治疗。在治疗开始至少2年后，对无病患者进行一次QOL测量。所有参与患者自行填写欧洲癌症研究与治疗组织（EORTC）QLQ - C30问卷和特定的H&N35模块。使用专门为该研究设计的问卷收集社会人口统计学数据。通过双变量分析，然后进行多变量分析，研究各种治疗、疾病和患者相关变量的QOL评分之间的关联。将EORTC QLQ - C30问卷的平均QOL评分与一般人群的平均评分进行比较。
159名符合条件的患者中，113名同意参与（97名男性和16名女性，中位年龄61岁，范围41 - 83岁）。初始治疗为49例患者接受EBRT加BT，27例接受手术加放疗，37例接受单纯EBRT。中位随访时间为62个月（范围24 - 110个月）。与一般人群相比，表明QOL受损最严重的三个评分是情感和社会功能以及疲劳。整体QOL受损的临床意义处于临界状态。身体功能、角色功能和疼痛评分与一般人群无显著差异。在多变量分析中，初始治疗对QOL的任何维度均无显著影响，但整体QOL和情感功能除外。令人惊讶的是，作为初始治疗，手术加放疗对情感功能评分有积极影响，而EBRT加BT对整体QOL评分有负面影响。这些治疗方式均未影响任何症状量表。这些矛盾结果至少部分归因于患者选择。
本研究结果为口咽癌长期生存者的QOL带来了原始且有用的数据。在这些患者中，QOL显著受损，尤其是在心理社会维度。无论初始治疗如何，症状和功能水平（整体QOL和情感功能除外）相似。这些结果表明应对过程的重要性。从长期角度比较治疗方案的试验中，生存仍然是最相关的终点，QOL评估应作为次要终点。需要对头颈部癌症患者的QOL进行更多前瞻性研究，以确定康复管理的新策略。
