Tansir Ghazal, Sharma Aparna, Biswas Bivas, Sah Suryadev Narayan, Roy Somnath, Deo S V S, Agarwala Sandeep, Khan Shah Alam, Bakhshi Sameer, Pushpam Deepam
Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India.
Front Oncol. 2024 Oct 21;14:1382856. doi: 10.3389/fonc.2024.1382856. eCollection 2024.
The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce.
This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023.
200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores.
Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment.
DT的医学管理包括酪氨酸激酶抑制剂（TKIs）、激素药物、抗炎药物，最近获批的γ-分泌酶抑制剂尼洛妥昔单抗是当前的标准治疗方法。关于DT不断演变的治疗格局的真实世界数据仍然稀缺。
这是一项对1995年至2020年期间在新德里全印度医学科学研究所和加尔各答塔塔医学中心登记的DT患者的回顾性研究。基线特征以中位数和四分位间距的形式进行分析。分类变量和连续变量分别通过卡方检验和独立样本t检验进行比较。在2022年至2023年期间，分别使用医院焦虑和抑郁量表（HADS）和癌症治疗功能评估通用量表（FACT-G）对30名患者进行前瞻性焦虑、抑郁和生活质量测量。
纳入200例患者，以男性为主（n = 111，55.5%），中位年龄26.5岁（2.5 - 75岁）。四肢（n = 100，50%）和腹部（n = 65，32.5%）是最常见的原发部位，接受的中位治疗线数为2（1 - 4）线。一线治疗包括手术（n = 116，58%）、全身治疗（n = 67，33.5%）、放疗（n = 10，5%）和主动监测（n = 7，3.5%）。一线全身治疗药物包括他莫昔芬（n = 55，27.5%）、伊马替尼（n = 7，3.5%）、索拉非尼（n = 1，0.5%）和化疗（n = 4，2%）。从2019年起，分别有3%和63%的患者接受了主动监测和手术。他莫昔芬获得的最佳放射学反应为疾病稳定（SD）（n = 76，59%）和部分缓解（PR）（n = 31，24.2%）。索拉非尼获得的最佳放射学反应为PR（n = 17，60.7%）和SD（n = 9，32.1%）。30例患者进行了HADS和FACT-G量表评估。HADS焦虑子量表的平均得分为3.6（±3.9 SD），HADS抑郁子量表的平均得分为2.6（±3.5 SD），各有2例（6.7%）患者存在具有临床意义的焦虑和抑郁。FACT-G量表的总体平均得分为87.5（±12.6 SD），较低的平均生理健康得分（p = 0.006）和情感健康得分（0.017）与较高的HADS焦虑得分（≥8分）显著相关。
评估焦虑、抑郁和生活质量对于衡量DT的心理影响至关重要。本研究概述了印度DT患者的临床和管理概况，但存在选择偏倚、人群异质性以及生活质量评估样本量小的局限性。
