Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset AB, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Eur J Surg Oncol. 2023 Nov;49(11):107008. doi: 10.1016/j.ejso.2023.107008. Epub 2023 Aug 3.
Neoadjuvant therapy in combination with surgery increases survival in gastroesophageal cancer; however, little is known about its impact on health-related quality of life. This study compared the impact of neoadjuvant therapy with that of surgery alone on the health-related quality of life in patients treated for gastroesophageal cancer.
A single-centre cohort study with prospectively collected data from patients undergoing curative intended treatment for gastroesophageal cancer between 2013 and 2020 was performed. Health-related quality of life was assessed prior to surgery and patients stratified according to neoadjuvant therapy or surgery alone. The primary endpoint was self-assessed health-related quality of life, evaluated using validated cancer-specific questionnaires. A pre-specified multivariable model adjusted for age, ASA score, and clinical T- and N-stage was used.
A total of 361 patients were included, of whom 239 (61%) were treated with neoadjuvant therapy. Patients treated with neoadjuvant therapy reported less difficulties with eating restrictions (-11.9, p = 0.005), pain (-10.9, p = 0.004), and insomnia (-12.6, p = 0.004) than patients treated with surgery alone. Patients with oesophageal cancer and neoadjuvant therapy reported less dysphagia (-16.6, p < 0.001), eating restrictions (-23.2, p < 0.001), and odynophagia (-18.0, p = 0.002) than those who underwent surgery alone.
Neoadjuvant therapy was associated with a significant reduction in symptoms affecting malnutrition and improved health-related quality of life in patients with gastroesophageal cancer. These results indicates that more patients might be available for neoadjuvant therapy, despite the baseline burden of gastroesophageal cancer.
新辅助治疗联合手术可提高胃食管交界处癌患者的生存率，但对其生活质量的影响知之甚少。本研究比较了新辅助治疗与单纯手术对胃食管交界处癌患者生活质量的影响。
对 2013 年至 2020 年期间接受根治性治疗的胃食管交界处癌患者进行前瞻性收集数据的单中心队列研究。在手术前评估健康相关生活质量，并根据新辅助治疗或单纯手术对患者进行分层。主要终点是使用经过验证的癌症特异性问卷评估自我评估的健康相关生活质量。使用预先指定的多变量模型调整年龄、ASA 评分和临床 T 期和 N 期。
共纳入 361 例患者，其中 239 例（61%）接受新辅助治疗。与单纯手术组相比，接受新辅助治疗的患者在进食受限（-11.9，p=0.005）、疼痛（-10.9，p=0.004）和失眠（-12.6，p=0.004）方面的报告较少。接受新辅助治疗的食管癌患者在吞咽困难（-16.6，p<0.001）、进食受限（-23.2，p<0.001）和咽喉痛（-18.0，p=0.002）方面的报告也少于单纯手术组。
新辅助治疗与胃食管交界处癌患者的营养不良相关症状减轻和生活质量改善显著相关。这些结果表明，尽管胃食管交界处癌的基线负担较重，但可能会有更多的患者接受新辅助治疗。
