Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, 4444 Forest Park, Suite 6700, St. Louis, MO 63108, USA.
Breast Cancer Res Treat. 2012 Jul;134(1):379-91. doi: 10.1007/s10549-012-2048-y. Epub 2012 Apr 8.
Little is known about quality-of-life (QOL) differences over time between incident ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer (EIBC) cases as compared with same-aged women without breast cancer (controls). We prospectively recruited and interviewed 1,096 women [16.8% DCIS, 33.3% EIBC (25.7% Stage I; and 7.6% Stage IIA), 49.9% controls; mean age 58; 23.7% non-white] at mean 6.7 weeks (T1), and 6.2 (T2), 12.3 (T3), and 24.4 months (T4) after surgery (patients) or screening mammogram (controls). We tested two hypotheses: (1) DCIS patients would report lower levels of QOL compared with controls but would report similar QOL compared with EIBC patients at baseline; and (2) DCIS patients' QOL would improve during 2-year follow-up and approach levels similar to that of controls faster than EIBC patients. We tested hypothesis 1 using separate general linear regression models for each of the eight subscales on the RAND 36-item Health Survey, controlling for variables associated with at least one subscale at T1. Both DCIS and EIBC patients reported lower QOL at T1 than controls on all subscales (each P<0.05). We tested hypothesis 2 using generalized estimating equations to examine change in each QOL subscale over time across the three diagnostic groups adjusting for covariates. By T3, physical functioning, role limitations due to physical problems, energy/fatigue, and general health each differed significantly by diagnostic group at P<0.05, because of larger differences between EIBC patients and controls; but DCIS patients no longer differed significantly from controls on any of the QOL subscales. At T4, EIBC patients still reported worse physical functioning (P=0.0001) and general health (P=0.0017) than controls, possibly because of lingering treatment effects. DCIS patients' QOL was similar to that of controls two years after diagnosis, but some aspects of EIBC patients' QOL remained lower.
目前对于新诊断的导管原位癌（DCIS）和早期浸润性乳腺癌（EIBC）患者与同年龄无乳腺癌女性（对照组）相比，其生活质量（QOL）随时间变化的差异知之甚少。我们前瞻性招募并访谈了 1096 名女性[16.8%的 DCIS，33.3%的 EIBC（25.7%为 I 期，7.6%为 IIA 期），49.9%为对照组；平均年龄 58 岁，23.7%为非白人]，在手术（患者）或筛查乳房 X 线摄影（对照组）后平均 6.7 周（T1）、6.2 周（T2）、12.3 周（T3）和 24.4 个月（T4）时进行测试。我们检验了两个假设：（1）与对照组相比，DCIS 患者报告的 QOL 水平较低，但与 EIBC 患者相比，基线时报告的 QOL 相似；（2）DCIS 患者的 QOL 将在 2 年随访期间得到改善，并比 EIBC 患者更快地接近对照组的水平。我们使用 RAND 36 项健康调查的八个子量表中的每个子量表的单独一般线性回归模型检验了假设 1，同时控制了与 T1 至少一个子量表相关的变量。在所有子量表上，DCIS 和 EIBC 患者在 T1 时报告的 QOL 均低于对照组（每项 P<0.05）。我们使用广义估计方程检验了假设 2，以在三个诊断组中，根据协变量来检查每个 QOL 子量表随时间的变化。到 T3 时，由于 EIBC 患者与对照组之间的差异较大，因此，在诊断组之间，身体功能、身体问题导致的角色限制、精力/疲劳和一般健康等方面均存在显著差异（每项 P<0.05）；但 DCIS 患者在任何 QOL 子量表上均不再与对照组有显著差异。在 T4 时，与对照组相比，EIBC 患者的身体功能（P=0.0001）和一般健康（P=0.0017）仍较差，这可能是由于治疗的持续影响。DCIS 患者的 QOL 在诊断两年后与对照组相似，但 EIBC 患者的某些方面的 QOL 仍较低。
