鼻窦恶性肿瘤治疗后的长期生活质量：一项前瞻性多中心研究。
Long-term quality of life after treatment in sinonasal malignancy: A prospective, multicenter study.
作者信息
Maoz Sabrina L, Wang Eric W, Hwang Peter H, Choby Garret, Kuan Edward C, Fleseriu Cara M, Chan Erik P, Adappa Nithin D, Geltzeiler Mathew, Getz Anne E, Humphreys Ian M, Le Christopher H, Abuzeid Waleed M, Chang Eugene H, Jafari Aria, Kingdom Todd T, Kohanski Michael A, Lee Jivianne K, Lazor Jillian W, Nabavizadeh Ali, Nayak Jayakar V, Palmer James N, Patel Zara M, Pinheiro-Neto Carlos D, Resnick Adam C, Smith Timothy L, Snyderman Carl H, St John Maie A, Storm Phillip B, Suh Jeffrey D, Wang Marilene B, Sim Myung S, Beswick Daniel M
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
出版信息
Int Forum Allergy Rhinol. 2023 Nov;13(11):2030-2042. doi: 10.1002/alr.23171. Epub 2023 May 9.
BACKGROUND
Quality of life (QOL) for individuals with sinonasal malignancy (SNM) is significantly under-studied, yet it is critical for counseling and may impact treatment. In this study we evaluated how patient, treatment, and disease factors impact sinonasal-specific and generalized QOL using validated metrics in a large cohort over a 5-year posttreatment time frame.
METHODS
Patients with SNM who underwent definitive treatment with curative intent were enrolled in a prospective, multisite, longitudinal observational study. QOL was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22) and University of Washington Quality of Life Questionnaire (UWQOL) instruments at pretreatment baseline and multiple follow-ups through 5 years posttreatment. Multivariable modeling was used to determine demographic, disease, and treatment factors associated with disease-specific and generalized physical and social/emotional function QOL.
RESULTS
One hundred ninety-four patients with SNM were analyzed. All QOL indices were impaired at pretreatment baseline and improved after treatment. SNOT-22 scores improved 3 months and UWQOL scores improved 6 to 9 months posttreatment. Patients who underwent open compared with endoscopic tumor resection had worse generalized QOL (p < 0.001), adjusted for factors including T stage. Pterygopalatine fossa (PPF) involvement was associated with worse QOL (SNOT-22, p < 0.001; UWQOL Physical dimension, p = 0.02). Adjuvant radiation was associated with worse disease-specific QOL (p = 0.03). Neck dissection was associated with worse generalized physical function QOL (p = 0.01). Positive margins were associated with worse generalized social/emotional function QOL (p = 0.01).
CONCLUSION
Disease-specific and generalized QOL is impaired at baseline in patients with SNM and improves after treatment. Endoscopic resection is associated with better QOL. PPF involvement, adjuvant radiation, neck dissection, and positive margins were associated with worse QOL posttreatment.
背景
鼻窦恶性肿瘤（SNM）患者的生活质量（QOL）研究明显不足，但它对咨询至关重要，且可能影响治疗。在本研究中，我们使用经过验证的指标，在一个大型队列中，对治疗后5年的时间范围内患者、治疗和疾病因素如何影响鼻窦特异性和总体生活质量进行了评估。
方法
对接受根治性意向明确治疗的鼻窦恶性肿瘤患者进行一项前瞻性、多中心、纵向观察性研究。在治疗前基线以及治疗后5年的多次随访中，使用22项鼻窦结局测试（SNOT - 22）和华盛顿大学生活质量问卷（UWQOL）工具评估生活质量。采用多变量建模来确定与疾病特异性以及总体身体和社会/情感功能生活质量相关的人口统计学、疾病和治疗因素。
结果
分析了194例鼻窦恶性肿瘤患者。所有生活质量指标在治疗前基线时均受损，治疗后有所改善。治疗后3个月SNOT - 22评分改善，6至9个月UWQOL评分改善。与内镜肿瘤切除术相比，接受开放性手术的患者总体生活质量较差（p < 0.001），对包括T分期等因素进行了调整。翼腭窝（PPF）受累与较差的生活质量相关（SNOT - 22，p < 0.001；UWQOL身体维度，p = 0.02）。辅助放疗与较差的疾病特异性生活质量相关（p = 0.03）。颈部清扫与较差的总体身体功能生活质量相关（p = 0.01）。切缘阳性与较差的总体社会/情感功能生活质量相关（p = 0.01）。
结论
鼻窦恶性肿瘤患者的疾病特异性和总体生活质量在基线时受损，治疗后改善。内镜切除术与更好的生活质量相关。PPF受累、辅助放疗、颈部清扫和切缘阳性与治疗后较差的生活质量相关。
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