Sagberg Lisa Millgård, Solheim Ole, Jakola Asgeir S
Department of Neurosurgery, St. Olavs University Hospital;
Department of Neuroscience, Norwegian University of Science and Technology;
J Neurosurg. 2016 Apr;124(4):989-97. doi: 10.3171/2015.4.JNS15194. Epub 2015 Oct 2.
By exploring longitudinal patient-reported health-related quality of life (HRQoL), the authors sought to assess the quality of survival for patients in the 1st year after diagnosis of glioblastoma.
Thirty unselected patients ≥ 18 years who underwent primary surgery for glioblastoma in the period 2011-2013 were included. Using the generic HRQoL questionnaire EQ-5D 3L, baseline HRQoL was assessed before surgery and at postoperative follow-up after 1, 2, 4, 6, 8, 10, and 12 months.
There was an apparent correlation between deterioration in HRQoL scores and tumor progression. Patients with permanent deterioration in HRQoL early after surgery represented a subgroup with rapid progression and short survival. Both positive and negative changes in HRQoL were more often seen after surgery than after radio- or chemotherapy. Patients with gross-total resection (GTR) reported better and more stable HRQoL. In a multivariable analysis preoperative cognitive symptoms (p = 0.02), preoperative functional status (p = 0.03), and GTR (p = 0.01) were independent predictors of quality of survival (area under the curve for EQ-5D 3L index values).
The results indicate that progression-free survival is not only a surrogate marker for survival, but also for quality of survival. Quality of survival seems to be associated with GTR, which adds further support for opting for extensive resections in glioblastoma patients with good preoperative functional levels.
通过探究患者报告的纵向健康相关生活质量（HRQoL），作者旨在评估胶质母细胞瘤诊断后第1年患者的生存质量。
纳入2011 - 2013年期间30例年龄≥18岁、接受胶质母细胞瘤初次手术的未筛选患者。使用通用的HRQoL问卷EQ - 5D 3L，在手术前以及术后1、2、4、6、8、10和12个月的随访中评估基线HRQoL。
HRQoL评分的恶化与肿瘤进展之间存在明显相关性。术后早期HRQoL持续恶化的患者代表了一个进展迅速且生存期短的亚组。HRQoL的正向和负向变化在手术后比在放疗或化疗后更常见。接受全切除（GTR）的患者报告的HRQoL更好且更稳定。在多变量分析中，术前认知症状（p = 0.02）、术前功能状态（p = 0.03）和GTR（p = 0.01）是生存质量（EQ - 5D 3L指数值的曲线下面积）的独立预测因素。
结果表明无进展生存期不仅是生存的替代指标，也是生存质量的替代指标。生存质量似乎与GTR相关，这进一步支持了对术前功能水平良好的胶质母细胞瘤患者选择进行广泛切除。
