Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Eur J Cancer. 2018 Mar;92:20-32. doi: 10.1016/j.ejca.2017.12.023. Epub 2018 Feb 3.
Quality of life (QOL) is impaired in pancreatic cancer patients. Our aim was to investigate the determinants and prognostic value of QOL after diagnosis in a hospital-based cohort of racially/ethnically diverse patients with pancreatic ductal adenocarcinoma (PDAC).
QOL was prospectively assessed using the Short Form-12 in 2478 PDAC patients. The Physical Component Summary (PCS) and Mental Component Summary (MCS) were categorised into tertiles based on their distribution. Ordered logistic regression was adopted to compare the risk of having lower PCS and MCS by patient sociodemographic and clinical characteristics. The association of PCS and MCS with mortality was assessed by Cox regression.
Compared with non-Hispanic whites, Hispanics were at significantly higher risk of having lower PCS (odds ratio [95% CI], 1.69 [1.26-2.26]; P < 0.001) and lower MCS (1.66 [1.24-2.23]; P < 0.001). Patients diagnosed with stage III (1.80 [1.10-2.94]; P = 0.02) and stage IV (2.32 [1.50-3.59]; P < 0.001) PDAC were more likely to have lower PCS than stage I patients. Other determinants of QOL included sex, age, drinking, smoking, education level, comorbidities and time since diagnosis. The low tertile of PCS (hazard ratio [95% CI], 1.94 [1.72-2.18]; P < 0.001) and MCS (1.42 [1.26-1.59]; P < 0.001) were each related to poor prognosis. Similar results were found for non-Hispanic whites as compared with African-Americans/Hispanics/others.
QOL after diagnosis is a significant prognostic indicator for patients with PDAC. Multiple factors determine QOL, suggesting possible means of intervention to improve QOL and outcomes of PDAC patients.
生活质量（QOL）在胰腺癌患者中受损。我们的目的是在一个基于医院的、种族/民族多样化的胰腺导管腺癌（PDAC）患者队列中，调查诊断后 QOL 的决定因素及其预后价值。
2478 例 PDAC 患者前瞻性地使用简短形式 12 项评估 QOL。根据分布情况，将身体成分综合评分（PCS）和心理成分综合评分（MCS）分为三分位。采用有序逻辑回归比较患者社会人口统计学和临床特征与较低 PCS 和 MCS 风险的关系。采用 Cox 回归评估 PCS 和 MCS 与死亡率的关系。
与非西班牙裔白人相比，西班牙裔患者 PCS 较低（优势比[95%CI]，1.69 [1.26-2.26]；P < 0.001）和 MCS 较低（1.66 [1.24-2.23]；P < 0.001）的风险显著更高。诊断为 III 期（1.80 [1.10-2.94]；P = 0.02）和 IV 期（2.32 [1.50-3.59]；P < 0.001）PDAC 的患者比 I 期患者更有可能 PCS 较低。QOL 的其他决定因素包括性别、年龄、饮酒、吸烟、教育程度、合并症和诊断后时间。PCS 低三分位（危险比[95%CI]，1.94 [1.72-2.18]；P < 0.001）和 MCS 低三分位（1.42 [1.26-1.59]；P < 0.001）与预后不良相关。非西班牙裔白人与非裔美国人/西班牙裔/其他人相比，结果相似。
诊断后 QOL 是 PDAC 患者的重要预后指标。多个因素决定了 QOL，这表明可能有改善 QOL 和 PDAC 患者结局的干预措施。
