调强放疗时代儿童与成人鼻咽癌生存者长期生活质量的比较及其预测因素分析。
Comparison of long-term quality of life and their predictors in survivors between paediatric and adult nasopharyngeal carcinoma in the intensity-modulated radiotherapy era.
机构信息
Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Centre, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Centre, Guangzhou, 510060, P. R. China.
出版信息
BMC Cancer. 2024 Oct 2;24(1):1223. doi: 10.1186/s12885-024-12966-4.
BACKGROUND
To compare the differences in long-term quality of life (QoL) between survivors of paediatric and adult patients with nasopharyngeal carcinoma (NPC) and assess the clinical factors that predict long-term QoL.
METHODS
We enrolled 420 long-term NPC survivors who were alive for at least 8 years after treatment, including 195 paediatric and 225 adult patients diagnosed and treated with intensity-modulated radiotherapy (IMRT) at Sun Yat-sen University Cancer Centre (SYSUCC) between 2011 and 2015. Data on clinical factors and EORTC QLQ-C30 were collected from all participants. The QoL of paediatric and adult NPC survivors was compared.
RESULTS
The paediatric group had significantly better outcomes in global health status (paediatric: 80.2 ± 12.7; adult: 77.2 ± 11.5; P = 0.027), physical function (paediatric: 98.5 ± 4.6; adult: 95.1 ± 7.0; P < 0.001), role function (paediatric: 97.0 ± 9.2; adult: 90.5 ± 15.2; P < 0.001), social function (paediatric: 96.0 ± 8.9; adult: 93.5 ± 11.8; P = 0.038), insomnia (paediatric: 1.9 ± 7.8; adult: 13.1 ± 22.3; P < 0.001), constipation (paediatric: 1.3 ± 7.5; adult: 8.0 ± 17.4; P < 0.001), diarrhea (paediatric: 0.7 ± 4.6; adult: 2.8 ± 9.3; P = 0.010), and financial difficulties (paediatric: 1.9 ± 7.8; adult: 11.0 ± 19.8; P < 0.001), but poorer cognitive function (paediatric: 88.3 ± 9.9; adult: 93.8 ± 12.6; P < 0.001) than the adult group. Pretreatment clinical factors, including T stage, N stage, and pre-treatment EBV (Epstein-Barr Virus) DNA, showed a strong association with QoL. However, the factors that affected the QoL outcomes differed between the two groups. In survivors of paediatric cancer, global health status/QoL was strongly correlated with T stage (P < 0.001) and clinical stage (P = 0.018), whereas it was strongly correlated with pre-treatment EBV DNA (P = 0.008) in adults.
CONCLUSION
Paediatric survivors of NPC have a significantly better QoL than adult NPC survivors. Moreover, pre-treatment T stage, N stage, and EBV DNA significantly influenced the overall health status of the survivors. These results highlight the need to tailor care to both age groups to promote better long-term health outcomes.
背景
比较儿童和成人鼻咽癌（NPC）幸存者的长期生活质量（QoL）差异，并评估预测长期 QoL 的临床因素。
方法
我们纳入了 420 名长期 NPC 幸存者，他们在中山大学肿瘤防治中心（SYSUCC）接受调强放疗（IMRT）治疗后至少存活 8 年，包括 195 名儿科和 225 名成人患者，这些患者分别于 2011 年至 2015 年被诊断和治疗。所有参与者均收集了临床因素和 EORTC QLQ-C30 的数据。比较了儿科和成人 NPC 幸存者的 QoL。
结果
儿科组在总体健康状况（儿科：80.2±12.7；成人：77.2±11.5；P=0.027）、身体功能（儿科：98.5±4.6；成人：95.1±7.0；P<0.001）、角色功能（儿科：97.0±9.2；成人：90.5±15.2；P<0.001）、社会功能（儿科：96.0±8.9；成人：93.5±11.8；P=0.038）、失眠（儿科：1.9±7.8；成人：13.1±22.3；P<0.001）、便秘（儿科：1.3±7.5；成人：8.0±17.4；P<0.001）、腹泻（儿科：0.7±4.6；成人：2.8±9.3；P=0.010）和经济困难（儿科：1.9±7.8；成人：11.0±19.8；P<0.001）方面的结局明显优于成人组，但认知功能（儿科：88.3±9.9；成人：93.8±12.6；P<0.001）较差。治疗前的临床因素，包括 T 分期、N 分期和治疗前 EBV（Epstein-Barr Virus）DNA，与 QoL 有很强的关联。然而，两组的 QoL 结局影响因素不同。在儿科癌症幸存者中，总体健康状况/QoL 与 T 分期（P<0.001）和临床分期（P=0.018）强烈相关，而在成人中则与治疗前 EBV DNA （P=0.008）强烈相关。
结论
与成人 NPC 幸存者相比，儿童 NPC 幸存者的 QoL 明显更好。此外，治疗前 T 分期、N 分期和 EBV DNA 显著影响幸存者的整体健康状况。这些结果强调需要针对不同年龄组制定护理计划，以促进更好的长期健康结局。
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