Giusti M, Sibilla F, Cappi C, Dellepiane M, Tombesi F, Ceresola E, Augeri C, Rasore E, Minuto F
Department of Endocrine and Metabolic Sciences, University of Genoa, Genoa, Italy.
J Endocrinol Invest. 2005 Jul-Aug;28(7):599-608. doi: 10.1007/BF03347258.
Although quality of life (QoL) has become an important aspect of cancer rehabilitation, psychometric studies on thyroid cancer patients are rare. We performed a case-controlled study on QoL in patients with differentiated thyroid carcinoma (DTC). QoL was evaluated in 61 patients with a history of DTC diagnosed from < 1 to 23 yr earlier. An undetectable thyroglobulin (Tg) level after recombinant human TSH (rhTSH) testing was considered the best predictor of cure. QoL was evaluated by means of a general psychiatric interview, the self-rating Kellner Symptoms Questionnaire (KSQ) and the Hamilton Depression Scale (HDS). QoL was also evaluated in a control group of subjects on L-T4 therapy with a non-toxic multinodular goiter diagnosed from < 1 to 25 yr earlier. DTC and control subjects were similar in age, male-female distribution and concomitant psychiatric therapies. Per-week dosage of L-T4 was higher in DTC patients than in controls (p < 0.01). In neither group of subjects was there any correlation between current TSH levels or interval from diagnosis and KSQ or HDS scores. Only in DTC patients was there a positive correlation between age and KSQ (p < 0.05) or HDS (p < 0.01) scores. There was a significant difference in overall KSQ scores between DTC (33.4 +/- 2.1) and control (24.5 +/- 1.9; p < 0.01) subjects. The subscales of KSQ showed a significant inter-group difference. HDS scores were higher in DTC subjects (35.8 +/- 1.0) than in controls (30.0 +/- 1.1; p < 0.01). HDS score was significantly (p = 0.02) higher in female than in male DTC patients. In patients with papillary carcinoma there was a positive correlation between the MACIS (metastases, age, completeness, invasiveness, size) score and KSQ (p = 0.01) or HDS (p < 0.01) scores. After rhTSH testing, detectable Tg levels were found in 13% of DTC patients. In Tg-positive patients, KSQ and HDS scores were not different from those of Tg-negative patients. After an 8-14 month period, a significant decrease in the KSQ scale somatization (p = 0.02) was found in a sub-set of 31 DTC patients. In conclusion, even in the age of rhTSH testing, DTC patients suffer an impairment of their QoL, as noted when short-term L-T4 withdrawal was the gold standard. Longitudinal evaluation seems to indicate a slight improvement in QoL when safe rhTSH testing is extensively used in the management of the disease.
尽管生活质量（QoL）已成为癌症康复的一个重要方面，但针对甲状腺癌患者的心理测量学研究却很少。我们对分化型甲状腺癌（DTC）患者的生活质量进行了一项病例对照研究。对61例在1至23年前被诊断为DTC的患者进行了生活质量评估。重组人促甲状腺激素（rhTSH）检测后甲状腺球蛋白（Tg）水平不可测被认为是治愈的最佳预测指标。通过一般精神科访谈、自评凯尔纳症状问卷（KSQ）和汉密尔顿抑郁量表（HDS）对生活质量进行评估。还对一组在1至25年前被诊断为非毒性多结节性甲状腺肿并接受L-T4治疗的对照组受试者进行了生活质量评估。DTC患者和对照组受试者在年龄、男女分布及伴随的精神科治疗方面相似。DTC患者的L-T4每周剂量高于对照组（p<0.01）。在两组受试者中，当前促甲状腺激素水平或诊断后的时间间隔与KSQ或HDS评分之间均无相关性。仅在DTC患者中，年龄与KSQ（p<0.05）或HDS（p<0.01）评分之间存在正相关。DTC患者（33.4±2.1）和对照组（24.5±1.9；p<0.01）的KSQ总分存在显著差异。KSQ的各子量表显示组间存在显著差异。DTC受试者的HDS评分（35.8±1.0）高于对照组（30.0±1.1；p<0.01）。女性DTC患者的HDS评分显著高于男性（p=0.02）。在乳头状癌患者中，MACIS（转移、年龄、完整性、侵袭性、大小）评分与KSQ（p=0.01）或HDS（p<0.01）评分之间存在正相关。rhTSH检测后，13%的DTC患者检测到可测的Tg水平。在Tg阳性患者中，KSQ和HDS评分与Tg阴性患者无差异。在31例DTC患者的一个亚组中，经过8至14个月的时间后，发现KSQ量表的躯体化症状显著下降（p=0.02）。总之，即使在rhTSH检测时代，DTC患者的生活质量仍受到损害，这在短期L-T4停药作为金标准时就已被注意到。纵向评估似乎表明，当安全的rhTSH检测广泛应用于该疾病的管理时，生活质量会有轻微改善。
