Staub-Bartelt Franziska, Obermayr Sarah, Sabel Michael, Rapp Marion
Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany.
Department for Orthopaedics and Traumatology, Kufstein Bezirkskrankenhaus, Kufstein, Austria.
Front Oncol. 2024 Nov 22;14:1457017. doi: 10.3389/fonc.2024.1457017. eCollection 2024.
Gliomas, the most common primary brain tumours, are classified based on histology and molecular genetics. Glioblastomas (GBM) are highly aggressive and are graded as WHO grade 4, while astrocytoma and oligodendrogliomas fall under WHO grades 2-3 (4). Gliomas affect 6 per 100,000 people, with a higher incidence in men. GBM has the poorest prognosis, whereas grade 2 astrocytoma and oligodendrogliomas show better outcomes. Quality of life (QoL) is now a crucial therapeutic goal alongside survival. Despite the impact of gliomas on QoL, especially given their incurability and progressive neurological deficits, research specifically comparing QoL and psycho-oncological stress in GBM versus grade 2 gliomas (glioma_2) remains limited. This study aims to fill that gap using validated measurement methods.
This retrospective, single-centre study investigated differences in QoL among neuro-oncological patients using the Karnofsky Performance Score (KPS), Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and EORTC-QLQ-C30-BN20. Data were collected before chemotherapy or radiotherapy to avoid therapy impact on QoL. Out of 2258 patients screened until June 30, 2022, 639 had glioblastoma or WHO grade 2 gliomas, with 223 meeting inclusion criteria for analysis.
The study included 161 GBM and 62 Glioma_2 patients, with 64% of all patients being male. The mean age was 58.11 years (SD ± 16.186). The DT did not show significant differences between GBM and glioma_2 glioma patients (median GBM:6 vs. 5 in glioma_2, p=0.480). However, the HADS-D indicates that GBM patients experience significantly more depression (median GBM 4.5 vs. 4 in glioma_2, p=0.033), though anxiety levels are similar in both groups (median GBM. 6 vs. 6 in glioma_2, p=0.867). The KPS (median GBM 70 vs. 90 in glioma_2, p<0.001) and specific aspects of the EORTC-QLQ-C30-BN20 questionnaire demonstrate that GBM patients have notably greater physical impairments than glioma_2 patients at diagnosis. Overall, GBM patients report worse quality of life compared to glioma_2 patients (median GBM 50 vs. 67 in glioma_2, p<0.001).
This study showed that distress is present in glioma patients regardless of their histopathological grading, even though GBM patients show higher depression levels and more physical limitations. Targeted anxiety management and early depression screening are essential for all glioma patients. Early QoL screening and making QoL a therapeutic goal benefits patient care and society.
胶质瘤是最常见的原发性脑肿瘤，根据组织学和分子遗传学进行分类。胶质母细胞瘤（GBM）具有高度侵袭性，属于世界卫生组织（WHO）4级，而星形细胞瘤和少突胶质细胞瘤属于WHO 2-3级（4）。胶质瘤的发病率为每10万人中有6例，男性发病率更高。GBM的预后最差，而2级星形细胞瘤和少突胶质细胞瘤的预后较好。生活质量（QoL）现在与生存一样是一个关键的治疗目标。尽管胶质瘤对生活质量有影响，特别是考虑到其无法治愈和进行性神经功能缺损，但专门比较GBM与2级胶质瘤（glioma_2）的生活质量和心理肿瘤学压力的研究仍然有限。本研究旨在使用经过验证的测量方法填补这一空白。
这项回顾性单中心研究使用卡诺夫斯基性能评分（KPS）、痛苦温度计（DT）、医院焦虑和抑郁量表（HADS）以及欧洲癌症研究与治疗组织生活质量核心问卷（EORTC-QLQ-C30-BN20）调查了神经肿瘤患者生活质量的差异。在化疗或放疗前收集数据，以避免治疗对生活质量的影响。在截至2022年6月30日筛选的2258例患者中，639例患有胶质母细胞瘤或WHO 2级胶质瘤，其中223例符合纳入标准进行分析。
该研究纳入了161例GBM患者和62例glioma_2患者，所有患者中64%为男性。平均年龄为58.11岁（标准差±16.186）。DT在GBM和glioma_2胶质瘤患者之间未显示出显著差异（GBM中位数：6，而glioma_2为5，p = 0.480）。然而，HADS-D表明GBM患者的抑郁情绪明显更严重（GBM中位数4.5，而glioma_2为4，p = 0.033），尽管两组的焦虑水平相似（GBM中位数6，而glioma_2为6，p = 0.867）。KPS（GBM中位数70，而glioma_2为90，p<0.001）以及EORTC-QLQ-C30-BN20问卷的特定方面表明，GBM患者在诊断时的身体损伤明显比glioma_2患者更严重。总体而言，与glioma_2患者相比，GBM患者报告的生活质量更差（GBM中位数50，而glioma_2为67，p<0.001）。
本研究表明，无论组织病理学分级如何，胶质瘤患者都存在痛苦，尽管GBM患者的抑郁水平更高，身体限制更多。针对性的焦虑管理和早期抑郁筛查对所有胶质瘤患者至关重要。早期生活质量筛查并将生活质量作为治疗目标有利于患者护理和社会。
