Gómez Vecchio Tomás, Corell Alba, Buvarp Dongni, Rydén Isabelle, Smits Anja, Jakola Asgeir S
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Front Oncol. 2021 Dec 21;11:792878. doi: 10.3389/fonc.2021.792878. eCollection 2021.
Recently, the Therapy-Disability-Neurology (TDN) was introduced as a multidimensional reporting system to detect adverse events in neurosurgery. The aim of this study was to compare the novel TDN score with the LandrielIbanez classification (LIC) grade in a large cohort of patients with diffuse lower-grade glioma (dLGG). Since the TDN score lacks validation against patient-reported outcomes, we described health-related quality of life (HRQoL) change in relation to TDN scores in a subset of patients.
We screened adult patients with a surgically treated dLGG World Health Organization (WHO) grade 2 and 3 between 2010 and 2020. Up until 2017, it consists of a retrospective cohort ( = 158). From 2017 and onwards, HRQoL was registered using EuroQoL-5-dimension, three levels of response (EQ-5D 3L) questionnaire at baseline and 3 months follow-up, in a prospectively recruited cohort ( = 102). Both the LIC grade and TDN score were used to classify adverse events.
In total, 231 patients were included. In 110/231 (47.6%) of the surgical procedures, a postoperative complication was registered. When comparing the TDN score to LIC grades, only a minor shift towards complications of higher order could be observed. EQ-5D 3L was reported for 45 patients. Patients with complications related to surgery had pre- to postoperative changes in EQ-5D 3L index values ( = 27; mean 0.03, 95% CI -0.06 to 0.11) that were comparable to patients without complications ( = 18; mean -0.06, 95% CI -0.21 to 0.08). In contrast, patients with new-onset neurological deficit had a deterioration in HRQoL at follow-up, with a mean change in the EQ-5D 3L index value of 0.11 ( = 13, 95% CI 0.0 to 0.22) compared to -0.06 ( = 32, 95% CI -0.15 to 0.03) for all other patients.
In patients with dLGG, TDN scores compared to the standard LIC tend to capture more adverse events of higher order. There was no clear relation between TDN severity and HRQoL. However, new-onset neurological deficit caused impairment in HRQoL. For the TDN score to better align with patient-reported outcomes, more emphasis on neurological deficit and function should be considered.
最近，治疗-残疾-神经学（TDN）作为一种多维报告系统被引入，用于检测神经外科手术中的不良事件。本研究的目的是在一大群弥漫性低级别胶质瘤（dLGG）患者中比较新的TDN评分与兰德里埃尔·伊瓦涅斯分类（LIC）分级。由于TDN评分缺乏针对患者报告结局的验证，我们在一部分患者中描述了与TDN评分相关的健康相关生活质量（HRQoL）变化。
我们筛选了2010年至2020年间接受手术治疗的世界卫生组织（WHO）2级和3级dLGG成年患者。直到2017年，它包括一个回顾性队列（n = 158）。从2017年及以后，在前瞻性招募的队列（n = 102）中，在基线和3个月随访时使用欧洲五维健康量表、三水平反应（EQ-5D 3L）问卷记录HRQoL。LIC分级和TDN评分均用于对不良事件进行分类。
总共纳入了231名患者。在110/231（47.6%）的手术中，记录到术后并发症。当将TDN评分与LIC分级进行比较时，仅观察到向更高级别并发症的轻微转变。45名患者报告了EQ-5D 3L。与手术相关并发症的患者术前至术后EQ-5D 3L指数值的变化（n = 27；平均值0.03，95%CI -0.06至0.11）与无并发症的患者（n = 18；平均值-0.06，95%CI -0.21至0.08）相当。相比之下，新发神经功能缺损的患者在随访时HRQoL恶化，EQ-5D 3L指数值的平均变化为0.11（n = 13，95%CI 0.0至0.22），而所有其他患者为-0.06（n = 32，95%CI -0.15至0.03）。
在dLGG患者中，与标准LIC相比，TDN评分倾向于捕捉到更多更高级别的不良事件。TDN严重程度与HRQoL之间没有明确的关系。然而，新发神经功能缺损导致HRQoL受损。为了使TDN评分更好地与患者报告的结局一致，应考虑更加强调神经功能缺损和功能。
