Leus Alet J G, Haisma Marjolijn S, Terra Jorrit B, Sidorenkov Grigory, Festen Suzanne, Plaat Boudewijn E C, Halmos György B, Racz Emoke
Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Dermatology. 2023;239(1):148-157. doi: 10.1159/000525974. Epub 2022 Aug 25.
Cutaneous squamous cell carcinoma is the second most common malignancy of the skin, often occurring in older patients and in the head and neck area (cSCCHN). Age, life expectancy, and frailty are not taken into consideration by current guidelines.
The objective of this study was to evaluate the influence of frailty and life expectancy on guideline deviation, treatment outcomes, and quality of life (QoL) after treatment in patients with cSCCHN.
Patients with cSCCHN were prospectively included. A geriatric assessment was performed, including the Geriatric 8 (G8), Groningen Frailty Indicator, and Timed Up and Go test (TUG). The Lee index was used to predict a limited life expectancy, and the Adult Comorbidity Evaluation-27 was used as a comorbidity index. QoL was assessed by the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire at three time points.
Seventy-seven patients with cSCCHN were included. Frail patients had significantly more high-risk tumours. Guideline deviation occurred in 7.8% and was more common in patients who were frail (G8), with high-risk tumours (≥T2), with a limited life expectancy or an increased TUG. Guideline deviation did not lead more often to progression of disease in our study. No predictors for post-operative complications were found. BaSQoL subscores were very low at each time point and did not change significantly with time in the total group. Frail patients reported more fear of recurrence or new tumours 3 months after treatment, and less concern about other people's skin 6 months after treatment, compared to non-frail patients. Complication rate, gender, or guideline deviation did not affect any subscale scores.
Assessment of frailty and life expectancy can guide physicians and patients in treatment decisions. Deviation from guidelines towards less aggressive treatment schedules can be considered in frail patients with a limited life expectancy, since it did not negatively affect short-term outcomes or QoL in patients with cSCCHN in our study. However, these results should be confirmed by other, larger prospective studies with a longer follow-up period.
皮肤鳞状细胞癌是皮肤第二常见的恶性肿瘤，常发生于老年患者及头颈部（皮肤鳞状细胞癌累及头颈部，cSCCHN）。目前的指南未考虑年龄、预期寿命和虚弱状况。
本研究的目的是评估虚弱和预期寿命对cSCCHN患者治疗后指南偏差、治疗结果及生活质量（QoL）的影响。
前瞻性纳入cSCCHN患者。进行了老年综合评估，包括老年8项评估量表（G8）、格罗宁根虚弱指数及计时起立行走测试（TUG）。使用李氏指数预测预期寿命有限，使用成人合并症评估-27作为合并症指数。在三个时间点通过基底细胞和鳞状细胞癌生活质量（BaSQoL）问卷评估生活质量。
纳入了77例cSCCHN患者。虚弱患者的高危肿瘤明显更多。指南偏差发生率为7.8%，在虚弱（G8）、有高危肿瘤（≥T2）、预期寿命有限或TUG增加的患者中更常见。在我们的研究中，指南偏差并未更常导致疾病进展。未发现术后并发症的预测因素。在每个时间点，BaSQoL子评分都非常低，且在总体组中随时间无显著变化。与非虚弱患者相比，虚弱患者在治疗后3个月报告对复发或新肿瘤的恐惧更多，在治疗后6个月对他人皮肤的关注更少。并发症发生率、性别或指南偏差均未影响任何子量表评分。
对虚弱和预期寿命的评估可指导医生和患者做出治疗决策。对于预期寿命有限的虚弱患者，可考虑偏离指南采用攻击性较小的治疗方案，因为在我们的研究中，这对cSCCHN患者的短期结果或生活质量没有负面影响。然而，这些结果应由其他更大规模、随访期更长的前瞻性研究予以证实。
