Ryder C Yoonhee, Bellile Emily L, VanKoevering Kyle K, McKean Erin L
University of Michigan Medical School, Office of Medical Student Education, Ann Arbor, Michigan, United States.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States.
J Neurol Surg B Skull Base. 2022 Oct 10;84(6):567-577. doi: 10.1055/a-1934-9377. eCollection 2023 Dec.
Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared with radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). This was a single-institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. A total of 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. Thirty-five percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all three models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24-0.45 on a 5-point Likert scale; -values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, 0.0412), especially in the vitality domain. This data demonstrates that hypopituitarism is an independent predictor of lower QoL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL.
长期以来，放射性垂体功能减退（RIH）一直被认为是颅底放疗的有害副作用之一。本研究旨在使用经过验证的前颅底问卷（ASBQ），评估RIH患者与未发生垂体功能减退的放疗患者的生活质量（QoL）。 这是一项单机构回顾性队列研究。纳入的患者有前颅底肿瘤病史，接受过至少一轮颅底放疗，并且在放疗后填写过至少一份ASBQ调查问卷。使用三种统计模型来确定垂体功能减退和治疗对QoL评分的影响。 共有145名患者符合纳入标准，分析了330份ASBQ调查问卷。35%（51/145）的患者在放疗后的某个时间点有RIH的证据。即使在调整了潜在的混杂因素和个体内相关性之后，垂体功能减退患者在所有三种模型中的总体ASBQ评分仍显著较低（在5分制李克特量表上平均下降0.24 - 0.45；P值范围为0.0004至0.018）。激素替代治疗使QoL的改善受到放疗后时间的调节，长期存活者（放疗后5年以上）从治疗中获益最大（在5分制李克特量表上增加0.89，P = 0.0412），尤其是在活力领域。 这些数据表明，垂体功能减退是QoL降低的独立预测因素。早期发现和适当治疗对于避免垂体功能减退对QoL的负面影响至关重要。
