Center for Endocrine Tumors Leiden, Department of Medicine.
Department of Neurosurgery, Department of Medicine.
Eur J Endocrinol. 2019 Oct;181(4):375-387. doi: 10.1530/EJE-19-0344.
Although widely advocated, applying Value Based Health Care (VBHC) in clinical practice is challenging. This study describes VBHC-based perioperative outcomes for patients with pituitary tumors up to 6 months postoperatively.
A total of 103 adult patients undergoing surgery were prospectively followed. Outcomes categorized according to the framework of VHBC included survival, degree of resection, endocrine remission, visual outcome (including self-perceived functioning), recovery of pituitary function, disease burden and health-related quality of life (HRQoL) at 6 months (Tier 1); time to recovery of disease burden, HRQoL, visual function (Tier 2); permanent hypopituitarism and accompanying hormone replacement (Tier 3). Generalized estimating equations (GEEs) analysis was performed to describe outcomes over time.
Regarding Tier 1, there was no mortality, 72 patients (70%) had a complete resection, 31 of 45 patients (69%) with functioning tumors were in remission, 7 (12%, with preoperative deficits) had recovery of pituitary function and 45 of 47 (96%) had visual improvement. Disease burden and HRQoL improved in 36-45% at 6 months; however, there were significant differences between tumor types. Regarding Tier 2: disease burden, HRQoL and visual functioning improved within 6 weeks after surgery; however, recovery varied widely among tumor types (fastest in prolactinoma and non-functioning adenoma patients). Regarding Tier 3, 52 patients (50%) had persisting (tumor and treatment-induced) hypopituitarism.
Though challenging, outcomes of a surgical intervention for patients with pituitary tumors can be reflected through a VBHC-based comprehensive outcome set that can distinguish outcomes among different patient groups with respect to tumor type.
尽管广泛提倡，但在临床实践中应用基于价值的医疗保健（VBHC）具有挑战性。本研究描述了术后 6 个月内接受垂体瘤手术的患者基于 VBHC 的围手术期结局。
前瞻性随访了 103 例成年手术患者。根据 VBHC 框架对结果进行分类，包括生存、切除程度、内分泌缓解、视觉结局（包括自我感知功能）、垂体功能恢复、疾病负担和健康相关生活质量（HRQoL），在 6 个月时（第 1 层）；疾病负担、HRQoL、视觉功能的恢复时间（第 2 层）；永久性垂体功能减退症和伴随的激素替代治疗（第 3 层）。使用广义估计方程（GEE）分析来描述随时间的变化。
第 1 层，无死亡病例，72 例（70%）患者行完全切除，45 例功能性肿瘤患者中 31 例（69%）缓解，7 例（术前有缺陷者占 12%）恢复了垂体功能，47 例（96%）患者视力改善。疾病负担和 HRQoL 在 6 个月时改善了 36-45%；然而，不同肿瘤类型之间存在显著差异。第 2 层：术后 6 周内疾病负担、HRQoL 和视觉功能得到改善；然而，不同肿瘤类型之间的恢复情况差异很大（催乳素瘤和无功能腺瘤患者恢复最快）。第 3 层，52 例（50%）患者存在持续性（肿瘤和治疗引起的）垂体功能减退症。
尽管具有挑战性，但通过基于 VBHC 的综合结果集，可以区分不同肿瘤类型患者的结果，从而反映出接受垂体瘤手术的患者的手术干预结果。
