University of Auckland, St George's University of London Medical School, University of Nicosia Medical School.
Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Thessaloniki.
Curr Opin Otolaryngol Head Neck Surg. 2022 Feb 1;30(1):46-57. doi: 10.1097/MOO.0000000000000774.
To assess the impact of benign and malignant sinonasal tumors and their management on patients' Quality of Life (QOL) as measured by Patient Reported Outcome Measures (PROMS).
Although there is a growing consensus that endoscopic surgical management in carefully selected patients with sinonasal tumors is at least as (and probably more) effective than open resection, it is not clear to what extent this translates to better QOL outcomes. Earlier studies reported better outcomes in the emotional and physical function domains after endoscopic resection, and it seems that postsurgical morbidity is less in endoscopic compared to open approaches. QoL after endoscopic surgery for sinonasal and anterior skull base tumors seems to improve within several months of surgery in both benign and malignant tumor groups. However, patients with benign sinonasal tumors have a higher QOL pre and post operatively compared to those with malignancy mainly due to absence of (neo) - adjuvant radiotherapy and/or chemotherapy. Factors that seem to be associated with worse QoL include > 60 years, less than 6 months from surgery, prior and adjuvant chemo and radiotherapy, smoking history, advanced staging and malignancy.
There is not a universally accepted PROM for use in patients with sinonasal benign and malignant tumors: A variety of different PROMs have been used with different degrees of effectiveness. Most likely a combination of disease-specific (such as SNOT 22 and anterior skull base questionnaire) and generic (such as Short Form health survey questionnaire (SF-36) and Karnofsky Performance Status) health outcome measures provide the most insight into QOL of patients with sinonasal tumors. QOL of these patients appears to undergo a bimodal impact with patients experiencing an initial dip in QOL after surgical treatment followed by a slow improvement over time. However, while patients with benign tumors' return to their status quo ante QOL, this is not the case for patients with malignant tumors who stabilize at a lower than initially QOL. To a large extent this seems to be the effect of (neo) adjuvant chemo radiotherapy.
评估良性和恶性鼻-鼻窦肿瘤及其治疗对患者生活质量(QOL)的影响,采用患者报告的结局测量(PROM)进行评估。
虽然越来越多的共识认为,对于经过精心选择的鼻-鼻窦肿瘤患者,内镜手术治疗至少与开放切除术一样(甚至可能更有效),但目前尚不清楚这在多大程度上转化为更好的 QOL 结果。早期研究报告称,内镜切除后在情感和身体功能方面的结果更好,而且与开放方法相比,内镜手术后的发病率似乎较低。内镜手术治疗鼻-鼻窦和前颅底肿瘤后,良性和恶性肿瘤组的 QOL 在术后几个月内似乎都有所改善。然而,与恶性肿瘤患者相比,良性鼻-鼻窦肿瘤患者术前和术后的 QOL 更高,主要原因是没有(新)辅助放化疗。与较差的 QOL 相关的因素包括年龄大于 60 岁、手术时间不足 6 个月、术前和辅助放化疗、吸烟史、晚期分期和恶性肿瘤。
目前尚无普遍接受的用于鼻-鼻窦良性和恶性肿瘤患者的 PROM:已使用了多种不同的 PROM,其有效性也各不相同。很可能是疾病特异性(如 SNOT 22 和前颅底问卷)和通用(如简明健康调查量表(SF-36)和卡诺夫斯基绩效状态)健康结果测量的组合,为鼻-鼻窦肿瘤患者的 QOL 提供了最深入的了解。这些患者的 QOL 似乎受到双模态影响,患者在手术治疗后最初经历 QOL 下降,然后随着时间的推移缓慢改善。然而,虽然良性肿瘤患者恢复到其 QOL 的原有状态,但恶性肿瘤患者并非如此,他们稳定在低于初始 QOL 的水平。在很大程度上,这似乎是(新)辅助化疗放疗的效果。