Dalton Jonathan F, Furdock Ryan, Cluts Landon, Jilakara Bharadwaj, Mcdonald Douglas, Calfee Ryan, Cipriano Cara
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA.
Cureus. 2022 May 31;14(5):e25534. doi: 10.7759/cureus.25534. eCollection 2022 May.
The Patient-Reported Outcomes Measurement Information System (PROMIS) assesses multiple aspects of patient well-being but has not been thoroughly studied amongst orthopedic oncology patients.
QUESTIONS/PURPOSES: How do preoperative/early postoperative PROMIS scores compare in patients with benign versus malignant soft tissue tumors (STTs) for (1) physical function, (2) pain interference, and (3) depression? Are the differences clinically relevant? What other patient/tumor factors impact PROMIS?
This retrospective cohort study included 314 STT patients who underwent resection of a benign (n = 187) or malignant (n = 127) STT over a period of 4.25 years at a single institution. PROMIS physical function, pain interference, and depression scores were collected preoperatively and at two and six weeks postoperatively. Scores for each time point were compared between groups and to preoperative baselines. Backward-stepwise linear mixed-effects models were produced to identify independent predictors of change in each PROMIS domain. The minimal clinically important difference (MCID) was 4 points.
The malignant cohort, but not the benign cohort, demonstrated clinically relevant worsening of physical function postoperatively. Malignant diagnosis (△ = -4.4, p < 0.001) and lower extremity tumors (△ = -4.5, p < 0.001) were identified as clinically relevant, independent predictors of worse physical function at all time points. No predictors of clinically relevant changes in pain interference or depression scores, including malignancy, were identified.
In STT patients, malignancy and lower extremity STT location are associated with clinically relevant worsening in physical function but do not significantly impact pain interference or depression in the early postoperative period. These findings may help establish the utility of PROMIS in an orthopedic oncology population.
患者报告结局测量信息系统（PROMIS）评估患者健康的多个方面，但尚未在骨肿瘤患者中进行深入研究。
问题/目的：对于（1）身体功能、（2）疼痛干扰和（3）抑郁，良性与恶性软组织肿瘤（STT）患者术前/术后早期的PROMIS评分如何比较？这些差异是否具有临床相关性？还有哪些患者/肿瘤因素会影响PROMIS？
这项回顾性队列研究纳入了314例STT患者，这些患者在单一机构于4.25年期间接受了良性（n = 187）或恶性（n = 127）STT切除术。术前、术后两周和六周收集PROMIS身体功能、疼痛干扰和抑郁评分。比较各时间点两组之间以及与术前基线的评分。建立向后逐步线性混合效应模型以确定每个PROMIS领域变化的独立预测因素。最小临床重要差异（MCID）为4分。
恶性肿瘤队列术后身体功能出现了具有临床相关性的恶化，而良性肿瘤队列未出现。恶性诊断（△ = -4.4，p < 0.001）和下肢肿瘤（△ = -4.5，p < 0.001）被确定为在所有时间点身体功能较差的具有临床相关性的独立预测因素。未发现包括恶性肿瘤在内的疼痛干扰或抑郁评分具有临床相关性变化的预测因素。
在STT患者中，恶性肿瘤和下肢STT位置与身体功能的临床相关性恶化相关，但在术后早期对疼痛干扰或抑郁没有显著影响。这些发现可能有助于确定PROMIS在骨肿瘤人群中的实用性。
