Division of Neurosurgery, University Health Network and Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Neuro Oncol. 2019 Jan 14;21(Suppl 1):i32-i43. doi: 10.1093/neuonc/noy152.
Few studies have evaluated the health-related quality of life (HRQoL) of patients with meningiomas. Here, we report the largest prospective, longitudinal cross-sectional cohort study of HRQoL in meningiomas to date, in order to identify possible actionable determinants of global HRQoL.
Adults who had undergone resection of a grade I intracranial meningioma and were in routine follow-up at a single large tertiary center underwent HRQoL assessment using the QLQ-C30 questionnaire administered opportunistically at follow-up visits. Averaged transformed QLQ-C30 scores at 12-month intervals were compared with scores from a normative reference population, with reference to known minimal clinically meaningful difference (CMD) in scores. To evaluate for possible determinants of changes in global HRQoL, global HRQoL scores were correlated (Spearman's Rho) with subdomain and symptom scores and with interval time from surgical resection.
A total of 291 postoperative patients with histologically confirmed and surgically treated grade I meningiomas consented to participation and a total of 455 questionnaires were included for analysis. Patients with meningiomas reported reduced global HRQoL at nearly every 12-month interval with clinically and statistically significant impairments at 12, 48, 108, and 120 months postoperative compared with the normative population (P < 0.05). Meningioma patients at the 12-month interval also reported a reduction of each subdomain of HRQoL assessment (P < 0.05); however, a CMD was only seen in cognitive functioning. Physical, emotional, cognitive, and social subdomains, as well as fatigue and sleep/insomnia, were significantly associated with global HRQoL at the first 12-month interval. Overall, there was no significant correlation between time from surgery and global HRQoL or the subdomain functional or symptom sections of the QLQ-C30.
Meningioma patients report considerable limitations in HRQoL for more than 120 months after surgery, particularly in cognitive, emotional, and social function, as well as suffering significant fatigue and sleep impairment compared with a normative reference population. The majority of these reported functional impairments and symptoms are strongly associated with global HRQoL and thus can be considered determinants of global HRQoL that if treated, have the potential to improve HRQoL for our meningioma patients. This hypothesis requires future study of targeted interventions to determine their efficacy.
很少有研究评估脑膜瘤患者的健康相关生活质量（HRQoL）。在这里，我们报告了迄今为止最大的脑膜瘤 HRQoL 前瞻性、纵向、横断面队列研究，以确定可能影响整体 HRQoL 的可操作决定因素。
在单一大型三级中心接受 I 级颅内脑膜瘤切除术并接受常规随访的成年人，在随访就诊时通过 QLQ-C30 问卷进行 HRQoL 评估。将 12 个月间隔的平均转换 QLQ-C30 评分与来自参考人群的评分进行比较，并参考评分的已知最小临床有意义差异（CMD）。为了评估全球 HRQoL 变化的可能决定因素，将全球 HRQoL 评分与亚域和症状评分以及手术切除后的时间间隔进行相关性分析（Spearman's Rho）。
共有 291 名经组织学证实和手术治疗的 I 级脑膜瘤患者同意参与，共纳入 455 份问卷进行分析。脑膜瘤患者在几乎每 12 个月的间隔时间报告 HRQoL 下降，与参考人群相比，术后 12、48、108 和 120 个月时的临床和统计学意义上的损伤（P < 0.05）。脑膜瘤患者在 12 个月间隔时间还报告了 HRQoL 评估的每个亚域的下降（P < 0.05）；然而，CMD 仅见于认知功能。身体、情绪、认知和社会亚域以及疲劳和睡眠/失眠与第一个 12 个月间隔的全球 HRQoL 显著相关。总体而言，手术时间与全球 HRQoL 或 QLQ-C30 的功能或症状部分之间没有显著相关性。
脑膜瘤患者在手术后 120 多个月报告 HRQoL 存在相当大的限制，尤其是在认知、情绪和社会功能方面，并且与参考人群相比，还会遭受严重的疲劳和睡眠障碍。这些报告的功能障碍和症状大多数与全球 HRQoL 密切相关，因此可以被认为是全球 HRQoL 的决定因素，如果得到治疗，有可能提高我们脑膜瘤患者的 HRQoL。这一假设需要进一步研究靶向干预措施来确定其疗效。
