Hoeller Ulrike, Kuhlmey Antje, Bajrovic Amira, Grader Kai, Berger Juergen, Tribius Silke, Fehlauer Fabian, Alberti Winfried
Department of Radiotherapy and Radiation Oncology, University Hospital, Hamburg, Germany.
Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):345-54. doi: 10.1016/s0360-3016(03)00589-3.
Long-term cosmesis from the patient's perspective is compared to the doctor's appraisal. Factors that determine judgment of cosmesis are analyzed. Also, a patient questionnaire was designed to screen for normal tissue reactions and is evaluated.
With structured questions, patients rated their satisfaction considering cosmesis, the difference in overall appearance, and specific changes of the breast. Two doctors rated cosmesis and radiation late effects (LENT/SOMA). Ratings were compared, and the relative impact of single items was studied. Two hundred eighty-seven patients with unilateral breast carcinoma were examined after a median follow-up of 8 years. They were treated between 1981 and 1995 with lumpectomy and radiotherapy of the breast with 1.8-2.5 Gy fractions with a median total dose of 55 Gy (range: 50-65 Gy).
One hundred sixty-one patients rated cosmesis as satisfying, 73 patients rated it as acceptable, and 25 patients as poor. Eighty-nine patients noted severe changes of appearance. Severe firmness and extensive scars were the most frequent complaint; the most important single item for judging cosmesis as poor was highly visible scars. Generally, doctors rated cosmesis less favorably (satisfactory, 150 patients; poor, 43 patients). Severe fibrosis was more important than discoloration of the breast or scars. Correlation between patients' and doctors' rating of cosmesis was modest (Cohen's weighted kappa 0.29), whereas the doctor's rating correlated well (0.55). Specificity and sensitivity of the questionnaire item for severe fibrosis (using doctors' judgments as gold standard) was 0.8; Cohen's weighted kappa was 0.34 (95% confidence interval: 0.21-0.48).
Rating of cosmesis is subjective. Patients' satisfaction with cosmesis is greater than the doctors' and is determined not only by radiation late effects, but also by factors unrelated to the appearance of the breast. Severe fibrosis may be detected by a patient questionnaire.
从患者角度对长期美容效果与医生的评估进行比较。分析决定美容效果评判的因素。此外，设计了一份患者问卷以筛查正常组织反应并进行评估。
通过结构化问题，患者对其在美容效果、整体外观差异以及乳房的具体变化方面的满意度进行评分。两名医生对美容效果和放射治疗晚期效应（LENT/SOMA）进行评分。对评分进行比较，并研究单个项目的相对影响。对287例单侧乳腺癌患者进行了检查，中位随访时间为8年。他们在1981年至1995年间接受了乳房肿块切除术和乳房放射治疗，每次分割剂量为1.8 - 2.5 Gy，中位总剂量为55 Gy（范围：50 - 65 Gy）。
161例患者将美容效果评为满意，73例患者评为尚可接受，25例患者评为差。89例患者指出外观有严重变化。严重的硬结和广泛的瘢痕是最常见的抱怨；将美容效果评为差的最重要单个项目是明显可见的瘢痕。总体而言，医生对美容效果的评价较低（满意，150例患者；差，43例患者）。严重纤维化比乳房变色或瘢痕更重要。患者和医生对美容效果评分之间的相关性一般（科恩加权kappa系数为0.29），而医生之间的评分相关性良好（0.55）。以医生的判断为金标准，问卷项目对严重纤维化的特异性和敏感性为0.8；科恩加权kappa系数为0.34（95%置信区间：0.21 - 0.48）。
美容效果的评分是主观的。患者对美容效果的满意度高于医生，其不仅由放射治疗晚期效应决定，还受与乳房外观无关的因素影响。通过患者问卷可能检测到严重纤维化。
