Bender Miriam, Tatagiba Marcos, Gharabaghi Alireza
Department of Neurosurgery and Neurotechnology, University Hospital and Faculty of Medicine, University of Tübingen, Tübingen, Germany.
Front Oncol. 2022 Feb 11;11:770789. doi: 10.3389/fonc.2021.770789. eCollection 2021.
Health-related quality of life (HRQoL) and self-reported outcome measures have a relevant impact on the medical decision-making process. They capture either the current status and allow for multiple prospective evaluations in the course of a treatment or rely on the retrospective comparison of health of patients before and after an intervention to assess its benefit. Importantly, these patient-assessed measures may be influenced by psychological factors. We compared HRQoL and perceived benefit in the course of surgical vestibular schwannoma (VS) treatment, as assessed by the patients from a prospective and retrospective point-of-view, and evaluated the influence of co-morbid depression.
Within a prospective observational single-center study, forty-three patients with VS were investigated before and after retrosigmoid tumor resection. SF-36, Beck Depression Inventory and patient-assessed clinical symptoms were acquired before surgery and at follow-up. At follow-up, the Glasgow Benefit Inventory (GBI) was acquired as well.
SF-36 scores were significantly lower than the age and sex matched normative data in six and three out of eight categories before and after surgery, respectively. Three categories improved significantly after vs. before surgery; one of them (global health) reached a minimal clinical important difference. In contrast, patients reported predominantly a deterioration, when asked for a retrospective evaluation of the benefit (i.e., GBI). Depression correlated with both SF-36 and GBI, determined dissatisfaction, improved significantly after surgery and was the measure that had the largest impact on HRQoL.
Prospective and retrospective HRQoL measures may lead to different findings and can be confounded by psychological factors.
健康相关生活质量（HRQoL）和自我报告结局指标对医疗决策过程具有重要影响。它们既可以反映当前状况，并在治疗过程中进行多次前瞻性评估，也可以依靠对患者干预前后健康状况的回顾性比较来评估其益处。重要的是，这些患者评估指标可能会受到心理因素的影响。我们从前瞻性和回顾性角度比较了手术治疗前庭神经鞘瘤（VS）过程中的HRQoL和感知益处，并评估了合并抑郁症的影响。
在一项前瞻性观察性单中心研究中，对43例VS患者在乙状窦后肿瘤切除术前和术后进行了调查。在手术前和随访时获取SF-36、贝克抑郁量表和患者评估的临床症状。在随访时，还获取了格拉斯哥益处量表（GBI）。
SF-36评分在手术前和术后分别在八个类别中的六个和三个类别中显著低于年龄和性别匹配的常模数据。与手术前相比，有三个类别在手术后有显著改善；其中一个类别（总体健康）达到了最小临床重要差异。相比之下，当被要求对益处进行回顾性评估时（即GBI），患者主要报告情况恶化。抑郁与SF-36和GBI均相关，决定了患者的不满情绪，手术后显著改善，并且是对HRQoL影响最大的指标。
前瞻性和回顾性HRQoL测量可能会导致不同的结果，并且可能会受到心理因素的混淆。
