Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Obstet Gynaecol. 2022 Jul;42(5):1217-1224. doi: 10.1080/01443615.2021.1945013. Epub 2021 Sep 23.
This study compared the quality of life (QoL) of 265 stage IA2-IIA cervical cancer patients treated with radical surgery alone (group 1: 137 patients) versus those who underwent primary radical surgery followed by radiotherapy (group 2: 128 patients) and identified clinical characteristics that predict the poor quality of life. All participants completed quality of life questionnaires: EORTC QLQ-C30 and CMU cervical cancer QoL. For the EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL scale and summary scores. Group 1 participants had better scores on the physical functioning domain and some symptom scales/items. For the CMU Cervical Cancer QoL, group 1 participants had better scores on gastrointestinal, lymphatic, and sexual/hormonal domains. In multivariable analysis, adjuvant radiation was consistently associated with poor quality of life in most domains. In general, early-stage cervical cancer survivors had a satisfactory quality of life. The clinical significance of the quality of life score differences between the study groups remains debateable.Impact statement For women with early cervical cancer, surgery is the main treatment providing not only a good chance for a cure by total removal of the cancer but also an opportunity to preserve the hormone-producing function of the ovary as well as the flexibility of the vagina. However, radiation treatment may be indicated after surgery in some patients depending on the findings from surgery. Because of the concern about increased complications and decreased long-term quality of life following the combined treatments, some may elect to avoid surgery and receive radiation alone in the first place. In this study, we compared the quality of life of women who had surgery alone to those who had surgery followed by radiation. This information is currently lacking in the medical literature. We found that, in general, women with early cervical cancer had a satisfactory quality of life. For a patient who is surgically fit and chooses to receive primary surgery, if radiation is subsequently required, she could still expect the acceptable long-term quality of life-although slightly less satisfactory than receiving surgery alone but not inferior to those who receive primary radiation treatment. These findings will be useful for pre-treatment counselling and posttreatment supportive care. The information regarding disease-related and treatment-induced morbidity should be thoroughly discussed with the patients before and after treatment. Also, the use of questionnaires examining general well-being together with a cancer-specific quality of life is recommended for the systematic evaluation of cancer survivors.
这项研究比较了 265 例 IA2-IIA 期宫颈癌患者的生活质量（QoL），这些患者分别接受了根治性手术（单纯手术组，n=137）或根治性手术加放疗（手术加放疗组，n=128）。本研究还确定了预测生活质量不良的临床特征。所有参与者均完成了生活质量问卷：EORTC QLQ-C30 和 CMU 宫颈癌 QoL。对于 EORTC QLQ-C30，研究组在总体健康状况/生活质量量表和综合评分方面具有可比性。与手术加放疗组相比，单纯手术组患者在身体功能领域和一些症状量表/项目上的评分更好。对于 CMU 宫颈癌 QoL，单纯手术组患者在胃肠道、淋巴和性/激素领域的评分更好。多变量分析显示，辅助放疗与大多数领域的生活质量不良均显著相关。总的来说，早期宫颈癌幸存者的生活质量令人满意。研究组间生活质量评分差异的临床意义仍存在争议。
影响声明对于早期宫颈癌女性，手术是主要治疗方法，不仅通过彻底切除癌症提供了良好的治愈机会，而且还有机会保留卵巢的激素产生功能以及阴道的灵活性。然而，根据手术结果，一些患者可能需要在手术后接受放疗。由于担心联合治疗后并发症增加和长期生活质量下降，一些患者可能会选择首先避免手术而单独接受放疗。在这项研究中，我们比较了单纯手术和手术加放疗的女性的生活质量。目前，这方面的信息在医学文献中还很缺乏。我们发现，一般来说，早期宫颈癌女性的生活质量令人满意。对于适合手术且选择接受初始手术的患者，如果随后需要放疗，她仍可以预期长期生活质量可接受-尽管略不如单独手术，但并不逊于那些接受初始放疗的患者。这些发现将有助于治疗前咨询和治疗后支持性护理。在治疗前后，应与患者彻底讨论与疾病相关和治疗引起的发病率。此外，建议使用检查一般健康状况和癌症特异性生活质量的问卷来系统评估癌症幸存者。
