Department of Head and Neck Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian.
Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China.
Int J Surg. 2023 Nov 1;109(11):3283-3293. doi: 10.1097/JS9.0000000000000620.
Surgical resection remains the cornerstone of treatment for locally advanced gastric cancer (LAGC) and is accompanied by potential deterioration in patients' health-related quality of life (HRQOL). As an important indicator of the psychosocial burden, HRQOL has become an essential endpoint to evaluate the efficacy and impact of cancer treatment. We examined longitudinal changes in HRQOL among patients with LAGC receiving total gastrectomy (TG) or distal gastrectomy (DG) over time.
The patients in this study were from a prospective observational study (NCT04408859) conducted during 2018-2022. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and the stomach module questionnaire to evaluate HRQOL at baseline and at postoperative months 1, 3, 6, and 12. We used linear mixed models to analyze longitudinal changes in HRQOL between groups and correlations with follow-up time.
A total of 219 patients were included. After propensity score matching, 186 patients were ultimately analyzed. Compared with the DG group, patients in the TG group reported significantly poorer global health status, physical functioning, and role functioning and more severe fatigue, insomnia, appetite loss, pain, and financial problems. Gastric-specific symptoms, dysphagia, chest and abdominal pain, reflux, restricted eating, and anxiety were more common and severe in the TG group. Most scales showed deterioration at months 1 and 3 after surgery, with gradual recovery thereafter, except the scales for global health status, pain, chest and abdominal pain, and reflux, which improved continually compared with baseline. TG was associated with worsening in at least six HRQOL domains for each measure after baseline, compared with DG.
In contrast with DG, TG had an adverse impact on postoperative HRQOL scales in patients with LAGC. Different HRQOL scales had various recovery trajectories after surgery. Effects of the gastrectomy scope on patients' HRQOL should be considered together with sound oncology principles.
手术切除仍然是局部晚期胃癌（LAGC）的治疗基石，但会伴随患者健康相关生活质量（HRQOL）的潜在恶化。作为心理社会负担的重要指标，HRQOL 已成为评估癌症治疗疗效和影响的重要终点。我们研究了接受全胃切除术（TG）或远端胃切除术（DG）的 LAGC 患者的 HRQOL 随时间的纵向变化。
本研究的患者来自于 2018 年至 2022 年进行的一项前瞻性观察性研究（NCT04408859）。我们使用欧洲癌症研究与治疗组织生活质量问卷核心 30 项和胃部模块问卷，在基线和术后 1、3、6 和 12 个月评估 HRQOL。我们使用线性混合模型分析两组之间 HRQOL 的纵向变化以及与随访时间的相关性。
共纳入 219 例患者。经过倾向评分匹配后，最终分析了 186 例患者。与 DG 组相比，TG 组患者的全球健康状况、身体功能和角色功能明显更差，疲劳、失眠、食欲减退、疼痛和经济问题更严重。胃部特异性症状、吞咽困难、胸腹痛、反流、限制进食和焦虑在 TG 组更为常见且严重。大多数量表在术后 1 个月和 3 个月时恶化，此后逐渐恢复，除了全球健康状况、疼痛、胸腹痛和反流量表，这些量表与基线相比持续改善。与 DG 相比，TG 与术后基线时至少六个 HRQOL 领域的恶化相关。
与 DG 相比，TG 对 LAGC 患者术后 HRQOL 量表有不良影响。不同的 HRQOL 量表在手术后有不同的恢复轨迹。胃切除术范围对患者 HRQOL 的影响应与健全的肿瘤学原则一起考虑。
