Nittala Mary R, Kanakamedala Madhava R, Mundra Eswar, Woods William C, Smith Maria L, Hamilton Robert D, Jefferson Gina D, Jackson Lana, Packianathan Satya, Vijayakumar Srinivasan
Radiation Oncology, University of Mississippi Medical Center, Jackson, USA.
Radiation Oncology, Texas Oncology, Amarillo, USA.
Cureus. 2021 Jan 30;13(1):e13022. doi: 10.7759/cureus.13022.
Introduction As traditional measures such as overall survival (OS) or disease-free survival (DFS) alone do not give a holistic view of the outcomes of a treatment paradigm, we determine to add the evidence of quality-adjusted life year (QALY) and disability-adjusted life year (DALY) to the outcomes of the nasopharyngeal carcinoma patients (NCP) treated with definitive chemoradiation therapy (chemoRT) with or without induction chemotherapy (induction chemo). Methods This is a retrospective analysis of 85 NCPs treated at an academic state institution. The OS estimated by the Kaplan-Meier method and the multivariate Cox regression model determined the co-variables associated with the OS. The relationship between QALYs gained and DALYs saved were calculated from age of the disease onset, duration of the disease, quality of life (QoL) and disability weights. Results Of the 85 eligible NCPs of this cohort, the disease frequency distribution per the World Health Organization (WHO) classification was 41.2% for Type-I, 42.4% for Type-II, and 16.5% for Type-III. The median follow-up (24 months). The five-year OS of patients treated with concurrent chemoRT . induction chemo followed by concurrent chemoRT was 54.7 . 14.8% for WHO Type I, 60.1 58.3% for WHO Type II, and 83.3 50.0% for WHO Type III (p=0.029). The average DALYs saved with concurrent chemoRT were 12.2 years 5 years for induction chemo followed by concurrent chemoRT. The average QALYs gained with concurrent chemoRT were 6.9 years 3.1 years for induction chemo followed by concurrent chemoRT. Conclusion Patients treated with concurrent chemoRT had an increased QoL when compared to induction chemo followed by concurrent chemoRT. The average DALYs saved were higher in the patients treated with concurrent chemoRT than treated with induction chemo followed by concurrent chemoRT.
引言 由于仅采用总生存期（OS）或无病生存期（DFS）等传统指标并不能全面反映一种治疗模式的结果，我们决定将质量调整生命年（QALY）和伤残调整生命年（DALY）的证据纳入接受确定性放化疗（chemoRT）联合或不联合诱导化疗（诱导化疗）的鼻咽癌患者（NCP）的治疗结果评估中。方法 这是一项对一家学术性国立机构治疗的85例NCP患者的回顾性分析。采用Kaplan-Meier法估计OS，并通过多变量Cox回归模型确定与OS相关的协变量。根据疾病发病年龄、病程、生活质量（QoL）和伤残权重计算获得的QALY与节省的DALY之间的关系。结果 在该队列的85例符合条件的NCP患者中，根据世界卫生组织（WHO）分类，疾病频率分布为：I型占41.2%，II型占42.4%，III型占16.5%。中位随访时间为24个月。同步放化疗患者的五年OS……诱导化疗后序贯同步放化疗的患者中，WHO I型为54.7……14.8%，WHO II型为60.1……58.3%，WHO III型为83.3……50.0%（p = ？0.029）。同步放化疗节省的平均DALY为12.2年……诱导化疗后序贯同步放化疗节省的平均DALY为5年。同步放化疗获得的平均QALY为6.9年……诱导化疗后序贯同步放化疗获得的平均QALY为3.1年。结论 与诱导化疗后序贯同步放化疗相比，同步放化疗治疗的患者生活质量有所提高。同步放化疗治疗的患者节省的平均DALY高于诱导化疗后序贯同步放化疗治疗的患者。
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