Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Ann Surg Oncol. 2013 Oct;20(11):3519-26. doi: 10.1245/s10434-013-3049-8. Epub 2013 Jun 8.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CS+HIPEC) is associated with significant perioperative morbidity. One goal of our ongoing patient-reported health-related quality of life (HRQoL) program is to describe the prognostic value of HRQoL measures for predicting postoperative morbidity and mortality following CS+HIPEC.
A retrospective analysis of a prospectively collected clinical database for all patients treated for peritoneal carcinomatosis and who participated in our patient-reported HRQoL program from 2001 to 2011 was done. Patients completed the Functional Assessment of Cancer Therapy questionnaire plus the colon symptom subscale, in addition to the Eastern Cooperative Oncology Group (ECOG) performance status rating prior to CS+HIPEC. The trial outcome index (TOI), a specific measure of function, symptoms, and physical well being of the patient, was analyzed. The TOI is a combination of the physical and functional well being subscales + the colon-specific subscale of the FACT-C.
Of 855 patients, 387 (45.2 %) participated in the HRQoL trials. Mean age was 53.3 years, and 213 (55 %) were female versus 174 (45 %) males. There were 240 patients (62 %) who had a complication versus 147 (38 %) who had no complication. A 30-day mortality rate of 7.7 % (30) was documented. Patients who suffered a 30-day postoperative mortality demonstrated a lower mean preoperative score in the FACT-C TOI 52.7 versus 61.7; P < 0.001. Independent predictors of 30-day mortality on multivariate analysis included TOI (0.05), age (0.001), and smoking (0.001). Patients with a higher TOI score were less likely to suffer a mortality (95 % CI 0.9-1.0, P = 0.05). Patients with a higher emotional well being (EWB) score were less likely to suffer a complication 0.9 (95 % CI 0.87-1.0, P = 0.04). Other independent predictors of postoperative morbidity included diabetic status (P = 0.05), ECOG performance status (0.001), and gender (0.02).
Preoperative HRQoL, as measured by FACT-C and ECOG performance status and added to traditional factors, helps predict postoperative morbidity and mortality following CS+HIPEC.
细胞减灭术联合腹腔热灌注化疗（CS+HIPEC）与显著的围手术期发病率有关。我们正在进行的患者报告的健康相关生活质量（HRQoL）计划的一个目标是描述 HRQoL 测量在预测 CS+HIPEC 术后发病率和死亡率方面的预后价值。
对 2001 年至 2011 年期间接受腹腔癌转移治疗并参加我们患者报告的 HRQoL 计划的所有患者的前瞻性收集临床数据库进行回顾性分析。患者在 CS+HIPEC 前完成了癌症治疗功能评估问卷加结肠症状亚量表，以及东部合作肿瘤学组（ECOG）表现状态评分。试验结局指数（TOI）是患者功能、症状和身体状况的特定衡量标准，对其进行了分析。TOI 是身体和功能健康子量表+ FACT-C 的结肠特异性子量表的组合。
在 855 名患者中，有 387 名（45.2%）参加了 HRQoL 试验。平均年龄为 53.3 岁，213 名（55%）为女性，174 名（45%）为男性。有 240 名（62%）患者发生并发症，147 名（38%）患者无并发症。记录到 30 天死亡率为 7.7%（30 人）。发生 30 天术后死亡的患者术前 FACT-C TOI 评分较低，为 52.7 分，而 61.7 分；P<0.001。多变量分析的 30 天死亡率的独立预测因素包括 TOI（0.05）、年龄（0.001）和吸烟（0.001）。TOI 评分较高的患者发生死亡的可能性较小（95%CI 0.9-1.0，P=0.05）。情绪健康评分较高的患者发生并发症的可能性较小 0.9（95%CI 0.87-1.0，P=0.04）。术后发病率的其他独立预测因素包括糖尿病状态（P=0.05）、ECOG 表现状态（0.001）和性别（0.02）。
术前 HRQoL 通过 FACT-C 和 ECOG 表现状态以及附加的传统因素进行测量，有助于预测 CS+HIPEC 术后发病率和死亡率。
