Mount Vernon Cancer Centre, Northwood, UK.
Division of Cancer Sciences, University of Manchester, Manchester, UK.
J Natl Cancer Inst. 2024 Jul 1;116(7):1087-1094. doi: 10.1093/jnci/djae039.
This article reports detailed quality-of-life data including preferred and actual place of care from SCORAD, the only large prospective randomized trial in metastatic spinal cord compression (MSCC).
SCORAD compared 2 doses of radiotherapy in patients with MSCC: 8 Gy single fraction and 20 Gy in 5 fractions. In total, 686 patients were randomized, of whom 590 had Health-Related Quality of Life (HRQoL) data collected at baseline and at least 1 later time point. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 supplemented with the QLU-C10D and data on place of care at weeks 1, 4, 8, and 12 postrandomization. Quality-of-Life Adjusted Survival was computed by multiplying Kaplan-Meier survival probabilities with the UK utility weights obtained from the QLU-C10D.
Patients with a baseline physical functioning score of above 50 demonstrated a 28% reduction in the risk of death (hazard ratio [HR] = 0.72, 99% confidence interval [CI] = 0.54 to 0.95; P = .003). An increased risk of death was associated with fatigue (HR = 1.35, 99% CI = 1.03 to 1.76; P = .0040), dyspnea (HR = 1.61, 99% CI = 1.24 to 2.08; P < .001), and appetite loss (HR = 1.25, 99% CI = 0.99 to 1.59; P = .014). The preferred place of care for the majority was at home or with relatives (61%-74% across the 12 weeks) but achieved by only 53% at 8 weeks.
Prolonged survival in patients with MSCC was associated with better HRQoL. More than 60% of patients preferred to be cared for at home or with relatives, but only half were able to achieve this. There was no difference in HRQoL between the multifraction and single-fraction groups.
ISRCTN97555949 and ISRCTN97108008.
本文报告了详细的生活质量数据，包括转移性脊髓压迫症（MSCC）唯一的大型前瞻性随机试验 SCORAD 中的首选和实际护理地点。
SCORAD 比较了 MSCC 患者的两种放射剂量：8 Gy 单次分割和 20 Gy 5 次分割。共有 686 名患者被随机分组，其中 590 名患者在基线和至少 1 个后续时间点收集了与健康相关的生活质量（HRQoL）数据。HRQoL 使用欧洲癌症研究与治疗组织生活质量问卷核心 30 量表测量，并补充了 QLU-C10D，以及随机分组后第 1、4、8 和 12 周的护理地点数据。通过将生存概率与 QLU-C10D 获得的英国效用权重相乘，计算了生活质量调整后的生存率。
基线身体功能评分高于 50 的患者死亡风险降低了 28%（风险比 [HR] = 0.72，99%置信区间 [CI] = 0.54 至 0.95；P = 0.003）。疲劳（HR = 1.35，99%CI = 1.03 至 1.76；P = 0.0040）、呼吸困难（HR = 1.61，99%CI = 1.24 至 2.08；P<0.001）和食欲下降（HR = 1.25，99%CI = 0.99 至 1.59；P = 0.014）与死亡风险增加相关。在 12 周内，大多数患者首选的护理地点是在家或与亲属在一起（61%-74%），但只有 53%的患者在 8 周内实现了这一目标。
MSCC 患者的生存时间延长与更好的 HRQoL 相关。超过 60%的患者希望在家或与亲属一起接受护理，但只有一半的患者能够实现这一目标。多分割组和单次分割组之间的 HRQoL 没有差异。
ISRCTN97555949 和 ISRCTN97108008。
