Qiu Li-Hong, Liang Shen-Hua, Wu Leilei, Huang Yang-Yu, Yang Tian-Zhen, Li Chuan-Zhen, Huang Xiao-Ling, Zhong Jiu-Di, Ma Guo-Wei
Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, Hangzhou, China.
J Thorac Dis. 2024 Sep 30;16(9):6064-6080. doi: 10.21037/jtd-24-311. Epub 2024 Sep 26.
BACKGROUND: The relationship between quality of life and survival outcomes in esophageal cancer patients following curative resection is not well established. This study aimed to longitudinally assess quality of life indicators and their association with overall survival (OS) in these patients. METHODS: A total of 232 patients were included in the study, and their quality of life was prospectively assessed at different time points using the European Organisation for Research and Treatment of Cancer (EORTC) 30-item core quality of life questionnaire (QLQ-C30) and the disease-specific esophageal module (QLQ-OES18). The scores of QLQ indicators at each time point were summarized, and changes in postoperative assessment were compared with preoperative assessments. The association of deterioration in certain indicators with OS was evaluated at each time point using Cox univariable analysis. Further confirmation of independent variables was carried out using Cox multivariable analysis. RESULTS: The study cohort comprised 62 females (26.7%), and 113 patients (48.7%) aged over 60 years. The median follow-up time was 80 months (range, 8-118 months). At 24 months after discharge, patients reported improvements in role function, fatigue, cognition function, emotional function, social function, insomnia, appetite loss, nausea and vomiting, constipation, financial status, trouble swallowing saliva, and pain related to esophageal cancer. However, physical function, dyspnea, diarrhea, global health status, choking when swallowing, trouble talking, and reflux remained compromised. Multivariable regression analysis revealed deterioration in role function, emotional function, and coughing difficulty at 6 months, and dyspnea, pain, and cognitive function at 24 months post-discharge were identified as independent prognostic factors for OS. CONCLUSIONS: Our findings underscore the importance of monitoring quality of life indicators in esophageal cancer patients as they may significantly influence survival outcomes. The identification of specific quality of life indicators as prognostic factors highlights the need for a patient-centered approach in clinical practice to enhance care and potentially improve survival.
背景：食管癌患者根治性切除术后生活质量与生存结果之间的关系尚未明确确立。本研究旨在纵向评估这些患者的生活质量指标及其与总生存期（OS）的关联。 方法：本研究共纳入232例患者，并使用欧洲癌症研究与治疗组织（EORTC）的30项核心生活质量问卷（QLQ-C30）和特定疾病的食管模块（QLQ-OES18）在不同时间点对其生活质量进行前瞻性评估。总结每个时间点QLQ指标的得分，并将术后评估的变化与术前评估进行比较。使用Cox单变量分析在每个时间点评估某些指标恶化与OS的关联。使用Cox多变量分析进一步确认自变量。 结果：研究队列包括62名女性（26.7%）和113名年龄超过60岁的患者（48.7%）。中位随访时间为80个月（范围8 - 118个月）。出院后24个月时，患者报告在角色功能、疲劳、认知功能、情绪功能、社交功能、失眠、食欲减退、恶心和呕吐、便秘、财务状况、吞咽唾液困难以及与食管癌相关的疼痛方面有所改善。然而，身体功能、呼吸困难、腹泻、总体健康状况、吞咽时窒息、说话困难和反流仍存在问题。多变量回归分析显示，出院后6个月时角色功能、情绪功能和咳嗽困难的恶化，以及出院后24个月时的呼吸困难、疼痛和认知功能被确定为OS的独立预后因素。 结论：我们的研究结果强调了监测食管癌患者生活质量指标的重要性，因为这些指标可能显著影响生存结果。将特定生活质量指标确定为预后因素凸显了在临床实践中采用以患者为中心的方法以加强护理并可能改善生存的必要性。
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