Esnaola Nestor F, Cantor Scott B, Johnson Margo L, Mirza Attiqa N, Miller Alexander R, Curley Steven A, Crane Christopher H, Cleeland Charles S, Janjan Nora A, Skibber John M
Department of Surgery, Pain Research Group, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4009, USA.
J Clin Oncol. 2002 Nov 1;20(21):4361-7. doi: 10.1200/JCO.2002.02.121.
Because survival in patients with locally recurrent rectal cancer (LRRC) is limited, pain control and quality of life (QOL) are important parameters. The purpose of this study was to assess the prevalence of posttreatment pain and QOL of patients with LRRC treated with nonsurgical palliation or resection and identify predictors of poor outcome.
Posttreatment pain severity and QOL were prospectively assessed in 45 patients with LRRC using the Brief Pain Inventory and Functional Assessment of Cancer Therapy-Colorectal questionnaire.
Fifteen patients received nonsurgical palliation, and 30 patients underwent resection of their pelvic tumors. There was a significant association between higher posttreatment pain scores and worse QOL (P <.001). Patients treated with nonsurgical palliation reported moderate to severe pain beyond the third month of treatment. Resected patients reported comparable levels of pain during the first 3 postoperative years, particularly after bony resections; long-term survivors (beyond 3 years), however, reported minimal pain and good QOL. Female sex, pelvic/sciatic pain at presentation, total pelvic exenteration, and bony resection were associated with higher rates of moderate to severe posttreatment pain (P =.04, P <.001, P =.04, and P =.02, respectively). Pain at presentation was an independent predictor of posttreatment pain (odds ratio, 7.4 [95% confidence interval, 1.8 to 30.3]; P =.006).
Patients with LRRC treated with nonsurgical palliation or resection experience significant levels of pain after treatment. Close posttreatment pain monitoring is warranted in patients presenting with pelvic pain, and more aggressive pain management strategies may improve posttreatment QOL.
由于局部复发性直肠癌（LRRC）患者的生存期有限，疼痛控制和生活质量（QOL）是重要参数。本研究的目的是评估接受非手术姑息治疗或手术切除的LRRC患者治疗后疼痛的发生率和生活质量，并确定预后不良的预测因素。
使用简明疼痛问卷和癌症治疗功能评估-结直肠癌问卷对45例LRRC患者的治疗后疼痛严重程度和生活质量进行前瞻性评估。
15例患者接受非手术姑息治疗，30例患者接受盆腔肿瘤切除。治疗后疼痛评分较高与生活质量较差之间存在显著关联（P<.001）。接受非手术姑息治疗的患者在治疗第三个月后报告有中度至重度疼痛。接受手术切除的患者在术后3年内报告的疼痛程度相当，尤其是在骨切除术后；然而，长期存活者（超过3年）报告疼痛轻微且生活质量良好。女性、就诊时盆腔/坐骨神经痛、全盆腔脏器切除术和骨切除术与中度至重度治疗后疼痛的发生率较高相关（分别为P =.04、P<.001、P =.04和P =.02）。就诊时的疼痛是治疗后疼痛的独立预测因素（优势比，7.4 [95%置信区间，1.8至30.3]；P =.006）。
接受非手术姑息治疗或手术切除的LRRC患者治疗后经历显著程度的疼痛。对于出现盆腔疼痛的患者，治疗后应密切监测疼痛情况，更积极的疼痛管理策略可能会改善治疗后的生活质量。
