Dabakuyo T S, Fraisse J, Causeret S, Gouy S, Padeano M-M, Loustalot C, Cuisenier J, Sauzedde J-M, Smail M, Combier J-P, Chevillote P, Rosburger C, Boulet S, Arveux P, Bonnetain F
Biostatistics and Epidemiology Unit, Medical Information Department, Centre Georges François Leclerc, Dijon, France.
Ann Oncol. 2009 Aug;20(8):1352-61. doi: 10.1093/annonc/mdp016. Epub 2009 May 25.
This prospective multicenter study assessed and compared the impact of different surgical procedures on quality of life (QoL) in breast cancer patients.
The EORTC QLQ-C30 and the EORTC QLQ-BR-23 questionnaires were used to assess global health status (GHS), arm (BRAS) and breast (BRBS) symptom scales, before surgery, just after surgery and 6 and 12 months later. The Kruskal-Wallis test with the Bonferroni correction was used to compare scores. A mixed model analysis of variance for repeated measurements was then applied to assess the longitudinal effect of surgical modalities on QoL.
Before surgery, GHS (P = 0.7807) and BRAS (P = 0.7688) QoL scores were similar whatever the surgical procedure: sentinel node biopsy (SLNB), axillary node dissection (ALND) or SLNB + ALND. As compared with other surgical groups, GHS 75.91 [standard deviation (SD) = 17.44, P = 0.041] and BRAS 11.39 (SD = 15.36, P < 0.0001) were better in the SLNB group 12 months after surgery. Whatever the type of surgery, GHS decreased after surgery (P < 0.0001), but increased 6 months later (P = 0.0016). BRAS symptoms increased just after surgery (P = 0.0329) and until 6 months (P < 0.0001) before decreasing (P < 0.0001).
SLNB improved GHS and BRAS QoL in breast cancer patients. However, surgeons must be cautious, SLNB with ALND results in a poorer QoL.
这项前瞻性多中心研究评估并比较了不同手术方式对乳腺癌患者生活质量（QoL）的影响。
使用欧洲癌症研究与治疗组织（EORTC）的QLQ-C30问卷和EORTC QLQ-BR-23问卷，在手术前、手术后即刻、术后6个月和12个月评估总体健康状况（GHS）、手臂（BRAS）和乳房（BRBS）症状量表。采用经Bonferroni校正的Kruskal-Wallis检验比较得分。然后应用重复测量的混合模型方差分析来评估手术方式对生活质量的纵向影响。
手术前，无论采用何种手术方式：前哨淋巴结活检（SLNB）、腋窝淋巴结清扫（ALND）或SLNB + ALND，GHS（P = 0.7807）和BRAS（P = 0.7688）生活质量得分相似。与其他手术组相比，SLNB组术后12个月的GHS为75.91[标准差（SD）= 17.44，P = 0.041]，BRAS为11.39（SD = 15.36，P < 0.0001），情况更好。无论手术类型如何，术后GHS均下降（P < 0.0001），但6个月后有所上升（P = 0.0016）。BRAS症状在术后即刻增加（P = 0.0329），并持续到6个月（P < 0.0001），之后下降（P < 0.0001）。
前哨淋巴结活检改善了乳腺癌患者的GHS和BRAS生活质量。然而，外科医生必须谨慎，前哨淋巴结活检联合腋窝淋巴结清扫会导致生活质量较差。
