Graduate Institute of Healthcare Administration, Kaohsiung Medical University, 807 Kaohsiung, Taiwan, ROC.
Eur J Surg Oncol. 2011 Aug;37(8):695-702. doi: 10.1016/j.ejso.2011.05.008. Epub 2011 Jun 12.
To analyze longitudinal changes in each subscale of a quality of life (QOL) measure and to explore their relationships to effective QOL predictors in breast cancer surgery patients.
This prospective study analyzed 172 patients at two tertiary academic hospitals. All patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its supplementary breast cancer measure (QLQ-BR23) at baseline and at 1 and 2 years postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation (GEE) before and after surgery.
A 2-year follow-up survey of the examined population revealed significant (P < 0.05) improvement in each QOL subscale. In both postoperative surveys, effect size was largest in the QLQ subscales for patients who had received mastectomy with reconstruction and lowest in those who had received modified radical mastectomy. After adjusting for time effects and baseline predictors, GEE approaches revealed the following explanatory variables for QOL: time, type of surgical procedure, age, chemotherapy, radiotherapy, hormone therapy, and preoperative functional status.
When evaluating QOL after breast cancer surgery, several factors other than the surgery itself should be considered. Patients should also be advised that their postoperative QOL might depend not only on the success of their operations, but also on their preoperative functional status.
分析生活质量（QOL）测量各分量表的纵向变化，并探讨其与乳腺癌手术患者有效 QOL 预测因子的关系。
本前瞻性研究分析了两家三级学术医院的 172 例患者。所有患者均在基线时和术后 1 年和 2 年时完成欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）及其补充乳腺癌量表（QLQ-BR23）。通过自举估计得出差异反应性估计的 95%置信区间。这些工具得出的分数在手术前后通过广义估计方程（GEE）进行解释。
对检查人群的 2 年随访调查显示，每个 QOL 分量表均有显著改善（P<0.05）。在两次术后调查中，接受乳房切除术和重建术的患者的 QLQ 分量表的效果大小最大，而接受改良根治性乳房切除术的患者的效果大小最小。在调整时间效应和基线预测因子后，GEE 方法显示 QOL 的以下解释变量：时间、手术类型、年龄、化疗、放疗、激素治疗和术前功能状态。
在评估乳腺癌手术后的 QOL 时，除手术本身外，还应考虑其他几个因素。还应告知患者，他们的术后 QOL 可能不仅取决于手术的成功，还取决于他们术前的功能状态。
