Factors Predicting Health-Related Quality of Life Recovery in Patients Undergoing Surgical Treatment for Renal Tumors: Prospective Evaluation Using the RAND SF-36 Health Survey

Background

Most newly diagnosed kidney cancers present at localized stages. With appropriate treatments, the cancer-specific survival rates of such patients are extremely high, which makes patients’ health-related quality of life (HRQoL) a relevant issue. To date, most of the available studies on HRQoL have been biased by the absence of baseline HRQoL assessments and by retrospective designs.

Objective

To evaluate the baseline HRQoL of patients with kidney cancer, comparative HRQoL during the first year after surgery, and the prognostic factors predictive of HRQoL recovery.

Design, setting, and participants

We prospectively collected the data of all patients undergoing surgery for kidney tumors at a tertiary academic referral center from February 2006 to September 2007.

Interventions

Patients underwent nephron-sparing surgery (NSS) or radical nephrectomy (RN).

Measurements

Patients were invited to self-complete the validated, Italian version of the RAND 36-Item Health Survey 1.0 (SF-36) before surgery, 6 mo after surgery, and 12 mo after surgery.

Results and limitations

Overall, 129 consecutive patients were evaluated. No significant differences were found between the baseline scores of our patients and age- and sex-matched normative data for the Italian general population. Comparing the baseline SF-36 scores to those at 6 mo and 12 mo, there was statistically significant worsening in the physical domains and improvement in the emotional domains (all p < 0.05). About 50–80% of patients returned to baseline scores 6 mo and 12 mo after surgery. Age, body mass index (BMI), educational level, occupational status, New York Heart Association (NYHA) functional class, tumor mode of presentation, pathologic stage, size, and histologic subtype were associated with 6-mo and 12-mo return to the baseline HRQoL scores. The main limitation of the study was the lack of a disease-specific questionnaire.

Conclusions

Most patients returned to preoperative HRQoL within 12 mo after RN or NSS. Several patient features, clinical variables, and pathologic tumor variables predict the return of HRQoL.     

慢性阻塞性肺疾病患者疾病不确定感与生存质量的相关性研究

目的探讨慢性阻塞性肺疾病（COPD）患者疾病不确定感、生存质量状况以及两者之间的关系。方法便利抽取住院治疗的稳定期COPD患者38例．应用Mishel疾病不确定感量表和慢性阻塞性肺疾病生存质量测评表测量其疾病不确定感及生存质量。结果COPD患者的疾病不确定感呈中等强度，评分为87．30±13．22；生存质量评分为84．17±6．13；COPD患者的疾病不确定感与生存质量评分呈显著正相关（均P〈0．05）。结论对COPD患者需加强健康教育和心理支持，提高其心理调节能力和社会适应能力，从而降低疾病不确定感，提高生存质量。     

肾替代治疗的前瞻性生存质量研究

目的:研究肾衰竭患者不同替代治疗早期阶段生存质量变化的差异.方法:采用WHOQOL-BRIEF量表对血透组、腹透组、肾移植组的终末期肾衰竭患者分别在治疗前后评价其生活质量.结果:治疗前3组患者的生活质量评分无统计学差异,经过替代治疗3个月后,3组患者的总评分均得到提高,以肾移植组和腹透组生活质量评分值提高较多而全面.结论:肾移植和腹膜透析早期阶段对终末期肾衰竭患者生存质量的改善较血液透析明显.     

抑郁对终末期肾病维持性血液透析患者生活质量的影响

目的:调查分析抑郁对终末期肾病(ESRD)维持性血液透析(HD)患者生活质量的影响.方法:(1)用肾脏疾病生活质量简表(KDQOL-SF)以及Zung抑郁自评量表(SDS)对66例ESRD维持性HD患者进行问卷调查.(2)分析一般情况、透析情况和各实验室指标对患者生活质量的影响.(3)分析抑郁对生活质量的影响.结果:(1)单因素分析发现生活质量在不同的年龄组、工作状态、文化程度、医疗负担和内瘘手术次数之间存在统计学差异,而不同的工作状态、内瘘手术次数之间仅SDS分值存在统计学差异(P＜0.001,P＝0.001),不存在透析情况和实验室指标的差异;(2)KDQOL-SF分值与SDS分值存在负相关(r =-0.781,P＜0.001);(3)逐步多元回归发现只有SDS分值一项对生活质量产生影响.结论:抑郁是导致ESRD维持性HD患者生活质量下降的重要原因.     

The Risk of Tumour Recurrence in Patients Undergoing Renal Transplantation for End-stage Renal Disease after Previous Treatment for a Urological Cancer: A Systematic Review

Context

Renal transplantation is the gold standard renal replacement therapy in end-stage renal disease owing to its superior survival and quality of life compared with dialysis. When the potential recipient has a history of cancer, the waiting period before renal transplantation is usually based on the Cincinnati Registry.

Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors

Background

Although partial nephrectomy (PN) has been associated with improved renal function compared with radical nephrectomy (RN) for renal cell carcinoma, the impact on overall survival (OS) remains controversial.

Objective

To evaluate comparative OS and renal function in patients following PN and RN for a renal mass where malignancy was not a confounding factor.

Design, setting, and participants

Using the Mayo Clinic Nephrectomy Registry, we retrospectively identified 442 patients with unilateral sporadic benign renal masses treated surgically with PN or RN between 1980 and 2008.

Outcome measurements and statistical analysis

The primary outcome measures were OS and the incidence of new-onset stage IV chronic kidney disease (CKD), determined using the Kaplan-Meier method. Cox models were used to test the association of nephrectomy type with these outcomes.

Results and limitations

Overall, 206 and 236 patients with benign renal masses were surgically treated with RN and PN, respectively. Patients who underwent RN were older (median age: 67 vs 64 yr; p = 0.02) and had larger tumors (median size: 5.0 vs 2.7 cm; p < 0.001). Median follow-up for patients still alive at last follow-up was 8.3 yr (range: 0.1–27.9 yr). Estimated OS (95% confidence interval [CI]) rates at 10 and 15 yr were 69% (62–76%) and 53% (45–62%) for RN compared with 80% (73–87%) and 74% (65–83%) following PN (p = 0.032). After adjusting for covariates of interest, patients treated with RN were significantly more likely to die from any cause (hazard ratio [HR]: 1.75; 95% CI, 1.08–2.83; p = 0.023) or develop stage IV CKD (HR: 4.23; 95% CI, 1.80–9.93; p < 0.001) compared with patients who underwent PN. Limitations include the retrospective design, selection bias for surgical approach, and referral bias to a tertiary care facility.

Conclusions

Our data suggest that PN may confer a clinical benefit for improved renal function and better OS compared with RN after excluding the confounding effect of malignancy.     

Long-term Distress After Radical Prostatectomy Versus Watchful Waiting in Prostate Cancer: A Longitudinal Study from the Scandinavian Prostate Cancer Group-4 Randomized Clinical Trial

Background

Studies enumerating the dynamics of physical and emotional symptoms following prostate cancer (PCa) treatment are needed to guide therapeutic strategy. Yet, overcoming patient selection forces is a formidable challenge for observational studies comparing treatment groups.

Objective

To compare patterns of symptom burden and distress in men with localized PCa randomized to radical prostatectomy (RP) or watchful waiting (WW) and followed up longitudinally.

Design, setting, and participants

The three largest, Swedish, randomization centers for the Scandinavian Prostate Cancer Group-4 trial conducted a longitudinal study to assess symptoms and distress from several psychological and physical domains by mailed questionnaire every 6 mo for 2 yr and then yearly through 8 yr of follow-up.

Intervention

RP compared with WW.

Outcome measurements and statistical analysis

A questionnaire was mailed at baseline and then repeatedly during follow-up with questions concerning physical and mental symptoms. Each analysis of quality of life was based on a dichotomization of the outcome (yes vs no) studied in a binomial response, generalized linear mixed model.

Results and limitations

Of 347 randomized men, 272 completed at least five questionnaires during an 8-yr follow-up period. Almost all men reported that PCa negatively influenced daily activities and relationships. Health-related distress, worry, feeling low, and insomnia were consistently reported by approximately 30–40% in both groups. Men in the RP group consistently reported more leakage, impaired erection and libido, and fewer obstructive voiding symptoms. For men in the WW group, distress related to erectile symptoms increased gradually over time. Symptom burden and distress at baseline was predictive of long-term outlook.

Conclusions

Cancer negatively influenced daily activities among almost all men in both treatment groups; health-related distress was common. Trade-offs exist between physiologic symptoms, highlighting the importance of tailored treatment decision-making. Men who are likely to experience profound long-term distress can be identified early in disease management.     

Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis

Background

While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option.

Temsirolimus in Daily Use: Results of a Prospective Multicentre Noninterventional Study of Patients with Metastatic Kidney Cancer

Background

Temsirolimus (TEMSR) was approved for treating advanced renal cell carcinoma (RCC) in 2007. Based on the data from a single phase 3 trial, it is recommended explicitly as first-line therapy for patients with a poor clinical prognosis.

Objective

The aim of this prospective multicentre trial (STARTOR) was to examine the effectiveness of TEMSR in daily clinical practice with a broader indication in the treatment of metastatic RCC.

Design, setting, and participants

Metastatic RCC patients treated with 25 mg of TEMSR weekly were submitted to a prospective systematic evaluation and follow-up in 87 German centres between January 2008 and October 2011 using standardised procedures.

Outcome measurements and statistical analysis

All data were centrally analysed by an independent clinical research organisation.

Results and limitations

This interim analysis of the STARTOR study included 386 patients. The observed toxicity was tolerable, the median dose intensity was 91% (interquartile range: 79–100%), and the median treatment duration was 20.1 wk (95% confidence interval [CI], 17.0–23.3 wk). Clinical benefit was seen in 157 patients (40.7%); the median progression-free and overall survival were 4.9 mo (95% CI, 4.2–5.6) and 11.6 mo (95% CI, 9.3–13.9), respectively. The effectiveness of TEMSR did not differ significantly in relation to the patient's age, histologic RCC subtype, or line of treatment. The major limitations were the noninterventional study design, limited information about Memorial Sloan-Kettering Cancer Center risk factors and detailed toxicity, and the lack of central radiologic review.

Conclusions

TEMSR is an effective and largely well-tolerated treatment alternative for metastatic RCC patients in daily clinical practice, irrespective of the patient's age, histologic RCC subtype, or line of treatment.     

院外健康指导对肠造口患者生活质量的影响

为探讨院外健康指导对肠造口患者生活质量的影响,选取2007年11月至2009年4月住院的肠造口患者50例作为实验组,进行饮食、造口护理技巧的指导,造口并发症的预防、日常生活指导及心理辅导等;选取2006年5月至2007年10月住院的肠造口患者50例作为对照组,进行常规护理。并对两组患者的生活质量进行比较。结果显示,实验组的50例肠造口患者在造口自我护理能力、社会适应能力方面明显优于对照组,P〈0．001;造口并发症的发生率明显低于对照组,P〈0．001。结果表明,院外健康指导能有效提高肠造日患者的生活质量,减少造口并发症的发生。     

Prostate Cancer Risks for Male BRCA1 and BRCA2 Mutation Carriers: A Prospective Cohort Study

BackgroundBRCA1 and BRCA2 mutations have been associated with prostate cancer (PCa) risk but a wide range of risk estimates have been reported that are based on retrospective studies.ObjectiveTo estimate relative and absolute PCa risks associated with BRCA1/2 mutations and to assess risk modification by age, family history, and mutation location.Design, setting, and participantsThis was a prospective cohort study of male BRCA1 (n = 376) and BRCA2 carriers (n = 447) identified in clinical genetics centres in the UK and Ireland (median follow-up 5.9 and 5.3 yr, respectively).Outcome measurements and statistical analysisStandardised incidence/mortality ratios (SIRs/SMRs) relative to population incidences or mortality rates, absolute risks, and hazard ratios (HRs) were estimated using cohort and survival analysis methods.Results and limitationsSixteen BRCA1 and 26 BRCA2 carriers were diagnosed with PCa during follow-up. BRCA2 carriers had an SIR of 4.45 (95% confidence interval [CI] 2.99–6.61) and absolute PCa risk of 27% (95% CI 17–41%) and 60% (95% CI 43–78%) by ages 75 and 85 yr, respectively. For BRCA1 carriers, the overall SIR was 2.35 (95% CI 1.43–3.88); the corresponding SIR at age <65 yr was 3.57 (95% CI 1.68–7.58). However, the BRCA1 SIR varied between 0.74 and 2.83 in sensitivity analyses to assess potential screening effects. PCa risk for BRCA2 carriers increased with family history (HR per affected relative 1.68, 95% CI 0.99–2.85). BRCA2 mutations in the region bounded by positions c.2831 and c.6401 were associated with an SIR of 2.46 (95% CI 1.07–5.64) compared to population incidences, corresponding to lower PCa risk (HR 0.37, 95% CI 0.14–0.96) than for mutations outside the region. BRCA2 carriers had a stronger association with Gleason score ≥7 (SIR 5.07, 95% CI 3.20–8.02) than Gleason score ≤6 PCa (SIR 3.03, 95% CI 1.24–7.44), and a higher risk of death from PCa (SMR 3.85, 95% CI 1.44–10.3). Limitations include potential screening effects for these known mutation carriers; however, the BRCA2 results were robust to multiple sensitivity analyses.ConclusionsThe results substantiate PCa risk patterns indicated by retrospective analyses for BRCA2 carriers, including further evidence of association with aggressive PCa, and give some support for a weaker association in BRCA1 carriers.Patient summaryIn this study we followed unaffected men known to carry mutations in the BRCA1 and BRCA2 genes to investigate whether they are at higher risk of developing prostate cancer compared to the general population. We found that carriers of BRCA2 mutations have a high risk of developing prostate cancer, particularly more aggressive prostate cancer, and that this risk varies by family history of prostate cancer and the location of the mutation within the gene.     

Perioperative Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Cava Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Experience

Background

Surgery for renal cell carcinoma (RCC) patients with inferior vena cava (IVC) thrombus above the hepatic veins is technically complex and associated with an increased risk of perioperative morbidity and mortality. However, minimal data exist that describe contemporary perioperative outcomes at major referral centers or the prognostic factors associated with poor outcomes.

Objective

To determine the preoperative predictors of major complications and 90-d mortality after surgery in RCC patients who have IVC thrombus above the hepatic veins.

Design, setting, and participants

We reviewed medical records of all RCC patients who had IVC tumor thrombus above hepatic veins and had had surgery between January 2000 and December 2012 at the Mayo Clinic, M.D. Anderson Cancer Center, University of Texas Southwestern Medical Center, and the University of Wisconsin Hospital.

Outcome measurement and statistical analysis

Major complications recorded were defined as ≥3A according to the Clavien-Dindo system within 90 d of surgery. Univariate and multivariate analyses were used to evaluate associations of preoperative variables with risk of major complications or 90-d mortality.

Results and limitations

A total of 162 patients were identified for study (level 3, 4 in 69, 93 patients, respectively, according to the Neves classification). Cardiopulmonary bypass was used in 60 of 162 patients (37.5%), and 40 patients (24.7%) had preoperative angioembolization. Major complications were reported in 55 patients (34.0%), with the most common being respiratory, cardiac, and hematologic issues. After multivariate analysis, preoperative systemic symptoms and level 4 thrombus were independently associated with increased risk of major complications. Mortality was reported in 17 patients (10.5%) within 90 d after surgery. After multivariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status (PS) and low serum albumin were preoperative factors independently associated with increased risk of 90-d mortality.

Conclusions

Contemporary perioperative mortality and major complication rates for RCC patients who have upper-level thrombus are 10% and 34%, respectively. Patients who have ECOG PS >1 or low serum albumin have increased risk for perioperative mortality.     

Deterioration in Quality of Life Following Hip Fracture: A Prospective Study

To examine longitudinal change in health- related quality of life (HRQoL) following hip fracture in elderly subjects, 32 patients with hip fractures and 29 sex-matched non-fracture control subjects (mean ± SD age 82 ± 8 and 86 ± 6 years respectively) were enrolled in a prospective, case–control study. Fracture subjects completed a generic questionnaire, Short Form 36 (SF-36), and a disease-targeted measure, the revised Osteoporosis Assessment Questionnaire (OPAQ2), on two separate occasions, within 1 week of fracture and 12–15 weeks after fracture. Controls completed both questionnaires on two occasions 12 weeks apart. SF-36 scores were significantly correlated with OPAQ2 in comparable domains of Physical Function (r= 0.76), General Health (r= 0.70) and Mental Health/Tension (r = 0.86). Control subjects had stable scores with the OPAQ2 and SF-36. At 3 months after fracture there was a significant reduction in HRQoL in the SF-36 domains Physical Function (–51%), Vitality (–24%) and Social Function (–26%) and in the OPAQ2 domains Physical Function (–20%), Social Activity (–49%) and General Health (–24%). Hip fracture patients thus had a lower baseline HRQoL and experienced a significant deterioration in HRQoL after hip fracture on both the SF-36 and OPAQ2. HRQoL should be part of a comprehensive assessment of the costs of osteoporosis including fracture-associated morbidity. Received: 21 October 1999 / Accepted: 15 November 1999     

消化道恶性肿瘤病人确诊初期生命质量纵向研究

目的探讨消化道恶性肿瘤病人确诊初期生命质量的纵向变化 ,为针对性护理干预提供理论依据。方法采用癌症康复评价简表 (CARES SF)、MSAS量表、社会支持评定量表、状态焦虑自评量表、贝克抑郁量表对 10 7例消化道恶性肿瘤病人进行 6个月的追踪调查。结果生命质量中生理、心理社会及与医务人员的关系评分在 6个月中较稳定 (均数变化 ,P >0 .0 5 ,相关性分析 ,P <0 .0 1) ;婚姻关系、性功能评分均显著增加 (均P <0 .0 1)。确诊初期的生命质量、疾病时间长短、性别、教育层次是 6个月后生命质量的预测变量 (P <0 .0 5 ,P <0 .0 1)。结论病人确诊初期的生命质量为中等 ,6个月后婚姻关系、性功能问题加重 ;生命质量的影响因素为确诊初期的生命质量、疾病时间长短、性别、教育层次。制订针对性的干预方案可望提高病人的生命质量。     

Superior Quality of Life and Improved Surgical Margins Are Achievable with Robotic Radical Prostatectomy After a Long Learning Curve: A Prospective Single-surgeon Study of 1552 Consecutive Cases

Background

Comparative studies suggest functional and perioperative superiority of robot-assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP).

Objective

To determine whether high-volume experienced open surgeons can improve their functional and oncologic outcomes with RARP and, if so, how many cases are required to surpass ORP outcomes and reach the learning curve plateau.

Design, setting, and participants

A prospective observational study compared two surgical techniques: 1552 consecutive men underwent RARP (866) or ORP (686) at a single Australian hospital from 2006 to 2012, by one surgeon with 3000 prior ORPs.

Outcome measurements and statistical analysis

Demographic and clinicopathologic data were collected prospectively. The Expanded Prostate Cancer Index Composite quality of life (QoL) questionnaire was administered at baseline, 1.5, 3, 6, 12, and 24 mo. Multivariate linear and logistic regression modelled the difference in QoL domains and positive surgical margin (PSM) odds ratio (OR), respectively, against case number.

Results and limitations

A total of 1511 men were included in the PSM and 609 in the QoL analysis. RARP sexual function scores surpassed ORP scores after 99 RARPs and increased to a mean difference at 861st case of 11.0 points (95% confidence interval [CI], 5.9–16.1), plateauing around 600–700 RARPs. Early urinary incontinence scores for RARP surpassed ORP after 182 RARPs and increased to a mean difference of 8.4 points (95% CI, 2.1–14.7), plateauing around 700–800 RARPs. The odds of a pT2 PSM were initially higher for RARP but became lower after 108 RARPs and were 55% lower (OR: 0.45; 95% CI, 0.22–0.92) by the 866th RARP. The odds of a pT3/4 PSM were initially higher for RARP but decreased, plateauing around 200–300 RARPs with an OR of 1.15 (0.68–1.95) at the 866th RARP. Limitations include single-surgeon data and residual confounding.

Conclusions

RARP had a long learning curve with inferior outcomes initially, and then showed progressively superior sexual, early urinary, and pT2 PSM outcomes and similar pT3 PSM and late urinary outcomes. Learning RARP was worthwhile for this high-volume surgeon, but the learning curve may not be justifiable for late-career/low-volume surgeons; further studies are needed.     

股骨头坏死患者生活质量临床研究

目的探讨股骨头坏死(ONFH)患者的生活质量及影响因素,为ONFH的治疗选择提供依据;探讨将生活质量作为其疗效评价的可行性。方法采用国际通用的SF-36量表对95例ONFH的住院患者和60例正常对照人群进行测量评分。155份量表的填写均为被调查者本人完成。95例ONFH患者按ARCO分期:Ⅰ期4例,Ⅱ期54例,Ⅲ期32例,Ⅳ期5例。界定Ⅰ～Ⅱ期为早期,Ⅲ～Ⅳ期为中晚期。将性别、年龄、职业、婚姻状况、文化程度、家庭收入等非疾病因素作为自变量,通过t检验、方差分析、多元逐步回归分析ONFH患者的生活质量及其影响因素。结果 ONFH组生活质量评分分别为躯体功能(PF)(69.42±16.16)分;躯体健康所致角色限制(RP)(24.11±34.91)分;躯体疼痛(BP)(67.02±14.36)分;总体健康(GH)(54.21±22.79)分;活力(VT)(65.42±22.65)分;社会功能(SF)(66.08±26.00)分;情绪问题所致角色限制(RE)(55.44±43.11)分;心理健康(MH)(65.73±18.96)分与正常组进行比较,差异有统计学意义(P0.01);早期和中晚期患者的PF、RP评分分别为(72.46±11.41)、(64.87±20.71)分和(19.74±31.60)、(38.16±37.10)分,差异有统计学意义(P0.05);非疾病因素对生存质量各维度均有影响,特别是文化程度和婚姻状况。结论生活质量的评价为ONFH治疗方法的选择提供了依据,把生活质量引入ONFH的疗效评价体系将更具有人性化。     

Prospective Evaluation of Quality of Life of Patients Receiving Either Abdominoperineal Resection or Sphincter-Preserving Procedure for Rectal Cancer

Background Study results on quality of life (QoL) between patients receiving an anterior resection (AR) or abdominoperineal resection (APR) for rectal cancer vary greatly. A main reason is grounded in unequal methodology. The aims of this study were to assess differences in perceived QoL over time among patients treated with AR or APR with a recommended study design and methodology.Methods In a prospective study, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and a tumor-specific module were administered to patients with rectal cancer before surgery, at discharge, and 3, 6, and 12 months after the operation. Comparisons were made between patients receiving an AR and those receiving an APR.Results Two hundred forty-nine patients were included; 46 patients received an APR and 203 an AR. QoL data were available for 212 patients, of which 112 were female and 100 male. No differences in the distribution of age, sex, or tumor stage were observed between groups. EORTC function scales showed no significant differences, including body image scales, between patients receiving an AR and those receiving an APR. In symptom scores, AR patients had more difficulty with diarrhea and constipation, whereas patients with APR experienced more impaired sexuality and pain in the anoperineal region. At discharge, patients receiving an AR were more confident about their future.Conclusions QoL in patients receiving an AR and those receiving an APR is not different. Although patients with APR experience more impaired sexuality, patients receiving an AR experience decreases in QoL because of impaired bowel function.