Bosma Ingeborg, Reijneveld Jaap C, Douw Linda, Vos Maaike J, Postma Tjeerd J, Aaronson Neil K, Muller Martin, Vandertop W Peter, Slotman Ben J, Taphoorn Martin J B, Heimans Jan J, Klein Martin
VU University Medical Center, Department of Neurology, Amsterdam, the Netherlands.
Neuro Oncol. 2009 Feb;11(1):51-8. doi: 10.1215/15228517-2008-049. Epub 2008 Jul 10.
The objective of this study was to compare the health-related quality of life (HRQOL) of long-term to short-term high-grade glioma (HGG) survivors, determine the prognostic value of HRQOL for overall survival, and determine the effect of tumor recurrence on HRQOL for long-term survivors. Following baseline assessment (after surgery, before radiotherapy), self-perceived HRQOL (using the Medical Outcomes Study Short Form 36 [SF-36]) and brain tumor-specific symptoms (using the 20-item Brain Cancer Module) were assessed every 4 months until 16 months after histological diagnosis. Kaplan-Meier survival analysis and the Cox proportional hazards model were performed to estimate overall survival of patients with impaired scores on the aggregated SF-36 higher-order summary scores measuring physical functioning on a physical component scale and on a mental component scale (MCS). Sixteen patients with a short-term survival (baseline and 4-month follow-up) and 16 with a long-term survival (follow-up until 16 months after diagnosis) were selected out of 68 initially recruited HGG patients. At baseline, the short-term and long-term survivors did not differ in their HRQOL. Between baseline and the 4-month follow-up, HRQOL of short-term survivors deteriorated, whereas the long-term survivors improved to a level comparable to healthy controls. Patients with impaired mental functioning (MCS) at baseline had a shorter median survival than patients with normal functioning. After accounting for differences in patient and tumor characteristics, however, mental functioning was not independently related to poorer overall survival. Not surprisingly, in the group of long-term survivors, the five patients with recurrence had a more compromised HRQOL at the 16-month follow-up compared to the 11 patients without recurrence. We concluded that baseline HRQOL is not related to duration of survival and that long-term survivors show improvement of HRQOL to a level comparable to that of the healthy.
本研究的目的是比较长期与短期高级别胶质瘤（HGG）幸存者的健康相关生活质量（HRQOL），确定HRQOL对总生存期的预后价值，并确定肿瘤复发对长期幸存者HRQOL的影响。在基线评估（手术后、放疗前）后，每4个月评估一次自我感知的HRQOL（使用医学结局研究简表36 [SF-36]）和脑肿瘤特异性症状（使用20项脑癌模块），直至组织学诊断后16个月。采用Kaplan-Meier生存分析和Cox比例风险模型来估计在汇总的SF-36高阶汇总评分中得分受损的患者的总生存期，这些评分在身体成分量表和心理成分量表（MCS）上测量身体功能。从最初招募的68例HGG患者中选出16例短期生存患者（基线和4个月随访）和16例长期生存患者（随访至诊断后16个月）。在基线时，短期和长期幸存者的HRQOL没有差异。在基线和4个月随访之间，短期幸存者的HRQOL恶化，而长期幸存者改善到与健康对照相当的水平。基线时心理功能受损（MCS）的患者的中位生存期比功能正常的患者短。然而，在考虑患者和肿瘤特征的差异后，心理功能与较差的总生存期没有独立相关性。不出所料，在长期幸存者组中，与1个无复发的11例患者相比，5例复发患者在16个月随访时的HRQOL受损更严重。我们得出结论，基线HRQOL与生存期无关，长期幸存者的HRQOL改善到与健康人相当的水平。
