Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Br J Surg. 2018 Nov;105(12):1630-1638. doi: 10.1002/bjs.10897. Epub 2018 Jun 27.
After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here.
A prospective discrete-choice experiment was conducted. Patients with oesophageal cancer completed questionnaires 4-6 weeks after nCRT, before surgery. Patients' preferences were quantified using scenarios based on five aspects: 5-year overall survival, short-term HRQoL, long-term HRQoL, the risk that oesophagectomy is still necessary, and the frequency of clinical examinations using endoscopy and PET-CT. Panel latent class analysis was used.
Some 100 of 104 patients (96·2 per cent) responded. All aspects, except the frequency of clinical examinations, influenced patients' preferences. Five-year overall survival, the chance that oesophagectomy is still necessary and long-term HRQoL were the most important attributes. On average, based on calculation of the indifference point between standard surgery and active surveillance, patients were willing to trade off 16 per cent 5-year overall survival to reduce the risk that oesophagectomy is necessary from 100 per cent (standard surgery) to 35 per cent (active surveillance).
Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.
在接受新辅助放化疗（nCRT）加手术治疗食管癌后，29%的患者在切除标本中出现病理完全缓解。nCRT 后进行主动监测（而非标准的食管癌切除术）可能会提高健康相关生活质量（HRQoL），但患者需要进行频繁的诊断性检查，而且尚不清楚生存情况是否比标准食管癌切除术差。本研究旨在探讨影响患者偏好的因素以及患者在手术和主动监测之间的权衡取舍。
前瞻性离散选择试验。在 nCRT 后 4-6 周，即手术前，患者完成了问卷调查。使用基于五个方面的情景来量化患者的偏好：5 年总生存率、短期 HRQoL、长期 HRQoL、仍需进行食管癌切除术的风险以及使用内镜和 PET-CT 进行临床检查的频率。采用面板潜在类别分析。
104 例患者中有 100 例（96.2%）做出了回应。除了临床检查的频率外，所有方面都影响了患者的偏好。5 年总生存率、仍需进行食管癌切除术的风险和长期 HRQoL 是最重要的属性。平均而言，根据标准手术和主动监测之间的无差异点计算，患者愿意以 16%的 5 年总生存率为代价，将食管癌切除术仍需进行的风险从 100%（标准手术）降低至 35%（主动监测）。
患者愿意牺牲大量的 5 年生存率来降低食管癌切除术仍需进行的风险。
