Fosså S D, Haugnes H S, Dahl A A, Kiserud C E, Fosså A, Skalleberg J, Myklebust T Å
Department of Oncology, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo.
Department of Oncology, University Hospital of North Norway, Tromsø; Department of Clinical Medicine, UiT, The Arctic University, Tromsø.
Ann Oncol. 2023 Dec;34(12):1165-1174. doi: 10.1016/j.annonc.2023.09.3101. Epub 2023 Sep 21.
The aim of this study was to characterize the prevalence of self-reported adverse health outcomes (AHOs), track changes in AHOs, and examine their impact on health-related quality of life (HrQoL) in testicular cancer survivors (TCSs) who were diagnosed between 1980 and 1994. These assessments were conducted during two survey waves (SWs), with the first occurring ∼12 years after surgery-only or platinum-based chemotherapy (PBCT), and the second ∼28 years after initial treatment. The study primarily focused on 'typical AHOs', which included Peripheral Sensory Neuropathy (PSN), Raynaud's phenomenon, Tinnitus, and Hearing loss.
A total of 427 TCSs were included in the evaluation, distributed as follows: surgery-only group (n = 155), PBCT-standard group with ≤850 mg cisplatin (n = 222), and PBCT-high group with >850 mg cisplatin (n = 50). For comparison of HrQoL, men from the general population served as a control group (referred to as 'Norms'). The statistical significance level was set at P < 0.05, and clinical importance, in terms of testing HrQoL differences, was defined as Δ ≥2.5 points.
A higher number of TCSs who underwent PBCT reported experiencing typical AHOs compared with those who had surgery only. The highest prevalence rates were observed among TCSs who had undergone PBCT-high. Further, the number of TCSs describing typical AHOs, except Raynaud's phenomenon, increased during the observation period of 16 years. At the last SW, a median of 4 AHOs (any type) were reported after PBCT-high compared with a median of 2 AHOs after Surgery-only or after PBCT-standard. With Surgery-only as reference, PBCT-high, but not PBCT-standard, was associated with decreasing physical HrQoL in the last SW (A2 Regression coefficient: -4.3; P = 0.008). When comparing all TCSs with Norms no clinically important difference in physical and mental HrQoL was observed at either SW. However, at the last SW, TCSs after PBCT-high therapy represented a subgroup of TCSs with clinically important impairment of HRQoL. Of the typical AHOs, only PSN reduced HrQoL. Chronic fatigue, pain, anxiety/depression, sexual dysfunction, unemployment, being single, and low education were additional covariates.
After a median of 28 years since their treatment, HrQoL in TCSs was found to be comparable to that of Norms. This similarity held true even though AHOs, especially after PBCT-high, were becoming more prevalent among TCSs. The study revealed that individuals with a history of PBCT-high are at a high risk of experiencing a significantly increased prevalence of long-term AHOs, which subsequently leads to diminished HrQoL. It is crucial to recognize and provide specialized attention to these TCSs during lifelong follow-up care.
本研究的目的是描述自我报告的不良健康结局（AHOs）的发生率，追踪AHOs的变化情况，并研究其对1980年至1994年间确诊的睾丸癌幸存者（TCSs）健康相关生活质量（HrQoL）的影响。这些评估在两个调查波次（SWs）中进行，第一次在仅接受手术或铂类化疗（PBCT）后约12年进行，第二次在初始治疗后约28年进行。该研究主要关注“典型AHOs”，包括周围感觉神经病变（PSN）、雷诺现象、耳鸣和听力损失。
共有427名TCSs纳入评估，分布如下：仅手术组（n = 155）、顺铂剂量≤850 mg的PBCT标准组（n = 222）和顺铂剂量>850 mg的PBCT高剂量组（n = 50）。为比较HrQoL，将来自普通人群的男性作为对照组（称为“标准组”）。统计学显著性水平设定为P < 0.05，就测试HrQoL差异而言，临床重要性定义为Δ≥2.5分。
与仅接受手术的TCSs相比，接受PBCT的TCSs报告出现典型AHOs的人数更多。在接受PBCT高剂量治疗的TCSs中观察到最高的发生率。此外，在16年的观察期内，除雷诺现象外，描述典型AHOs的TCSs数量有所增加。在最后一次SW时，PBCT高剂量组报告的AHOs（任何类型）中位数为4个，而仅手术组或PBCT标准组后为2个。以仅手术组为参照，在最后一次SW时，PBCT高剂量组而非PBCT标准组与身体HrQoL下降相关（A2回归系数：-4.3；P = 0.008）。当将所有TCSs与标准组进行比较时，在任何一次SW时，身体和心理HrQoL均未观察到具有临床重要意义的差异。然而，在最后一次SW时，接受PBCT高剂量治疗后的TCSs代表了一组HrQoL受到临床重要损害的TCSs。在典型AHOs中，只有PSN降低了HrQoL。慢性疲劳、疼痛、焦虑/抑郁、性功能障碍、失业、单身和低教育程度是其他协变量。
在治疗后的中位数28年后，发现TCSs的HrQoL与标准组相当。即使AHOs，尤其是PBCT高剂量治疗后，在TCSs中变得更加普遍，这种相似性仍然成立。该研究表明，有PBCT高剂量治疗史的个体经历长期AHOs发生率显著增加的风险很高，这随后导致HrQoL下降。在终身随访护理期间识别并对这些TCSs给予专门关注至关重要。
