From the Institute of Clinical Pharmacology, Goethe - University, Frankfurt am Main, Germany (JL), Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt am Main, Germany (JL), DataBionics Research Group, Faculty of Mathematics and Computer Science, University of Marburg, Marburg, Germany (AU) and Department of Perioperative Medicine, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (EK).
Eur J Anaesthesiol. 2020 Mar;37(3):235-246. doi: 10.1097/EJA.0000000000001116.
Persistent pain extending beyond 6 months after breast cancer surgery when adjuvant therapies have ended is a recognised phenomenon. The evolution of postsurgery pain is therefore of interest for future patient management in terms of possible prognoses for distinct groups of patients to enable better patient information.
OBJECTIVE(S): An analysis aimed to identify subgroups of patients who share similar time courses of postoperative persistent pain.
Prospective cohort study.
Helsinki University Hospital, Finland, between 2006 and 2010.
A total of 763 women treated for breast cancer at the Helsinki University Hospital.
Employing a data science approach in a nonredundant reanalysis of data published previously, pain ratings acquired at 6, 12, 24 and 36 months after breast cancer surgery, were analysed for a group structure of the temporal courses of pain. Unsupervised automated evolutionary (genetic) algorithms were used for patient cluster detection in the pain ratings and for Gaussian mixture modelling of the slopes of the linear relationship between pain ratings and acquisition times.
Clusters or groups of patients sharing patterns in the time courses of pain between 6 and 36 months after breast cancer surgery.
Three groups of patients with distinct time courses of pain were identified as the best solutions for both clustering of the pain ratings and multimodal modelling of the slopes of their temporal trends. In two clusters/groups, pain decreased or remained stable and the two approaches suggested/identified similar subgroups representing 80/763 and 86/763 of the patients, respectively, in whom rather high pain levels tended to further increase over time.
In the majority of patients, pain after breast cancer surgery decreased rapidly and disappeared or the intensity decreased over 3 years. However, in about a tenth of patients, moderate-to-severe pain tended to increase during the 3-year follow-up.
乳腺癌手术后辅助治疗结束后持续超过 6 个月的疼痛是一种公认的现象。因此，手术后疼痛的演变对于未来的患者管理具有重要意义，以便为不同患者群体提供可能的预后，从而更好地为患者提供信息。
分析旨在确定具有相似术后持续性疼痛时间过程的患者亚组。
前瞻性队列研究。
芬兰赫尔辛基大学医院，2006 年至 2010 年。
共 763 名在赫尔辛基大学医院接受乳腺癌治疗的女性。
采用数据科学方法对先前发表的数据进行非冗余重新分析，分析乳腺癌手术后 6、12、24 和 36 个月时疼痛评分的时间过程的分组结构。采用无监督自动进化（遗传）算法对疼痛评分进行患者聚类检测，并对疼痛评分与获取时间之间的线性关系斜率进行高斯混合建模。
乳腺癌手术后 6 至 36 个月之间疼痛时间过程中存在模式的患者聚类或组。
为聚类疼痛评分和多峰建模疼痛时间趋势斜率，确定了三个具有不同疼痛时间过程的患者组作为最佳解决方案。在两个聚类/组中，疼痛减轻或保持稳定，两种方法分别建议/确定了类似的亚组，分别代表 80/763 和 86/763 的患者，他们的疼痛水平相当高，往往随着时间的推移进一步增加。
在大多数患者中，乳腺癌手术后的疼痛迅速减轻并消失或强度在 3 年内逐渐降低。然而，约十分之一的患者中，中度至重度疼痛在 3 年随访期间有增加的趋势。
