Effect of radiotherapy on long-term quality of life in recurrence-free rectal cancer survivors (LaTE study): nationwide inverse probability of treatment-weighted registry-based cohort study and survey.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae091
Yasir G Malik, Jūratė Šaltytė Benth, Hanne M Hamre, Arne E Færden, Johannes K Schultz
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Abstract

Background: Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up.

Methods: All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes.

Results: Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: -6.96 (95% c.i. -8.72 to -5.19); P < 0.001). Among patients without a stoma the mean difference was -8.1 points, whereas it was -5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group.

Conclusion: Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.

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放疗对无复发直肠癌幸存者长期生活质量的影响(LaTE 研究):全国范围内基于治疗的反概率登记加权队列研究和调查。
背景:放疗可减少局部晚期直肠癌的局部复发,但可能对未复发的患者造成伤害。该研究旨在调查放疗对直肠癌根治性治疗后(即随访期间未复发的患者)长期生活质量的影响:方法:通过挪威癌症登记处对2007年9月30日至2020年10月1日期间在挪威接受直肠癌手术的所有75岁以下患者进行识别。排除标准为远处转移、复发和痴呆。主要结果指标为胃肠道生活质量指数。次要结果测量包括 36 项简表调查。在评估结果差异时,采用基于多元逻辑回归模型的逆概率权重来平衡放疗组和未放疗组之间的预选协变量:在 5014 名受邀患者中,有 2142 名(43%)符合条件的患者回答了问卷。其中762人(36%)接受了新辅助放疗加手术治疗,1380人(64%)接受了单纯手术治疗。平均随访时间分别为 6.4 年和 7.4 年。经过倾向评分匹配后,接受放射治疗和未接受放射治疗的患者的胃肠道生活质量指数有显著差异(平均值(s.d.),平均分分别为 103.8(19.4)和 110.8(19.6),平均差异为-6.96(95% c.d.)):-6.96(95% 置信区间:-8.72 至-5.19);P < 0.001)。无造口患者的平均差异为-8.1分,而有造口患者为-5.7分。与单纯手术组相比,放疗组在8个36项简表调查领域中的7个领域的得分也明显较低:结论:与未接受放射治疗的患者相比,随访期间未复发的患者的长期生活质量明显较低。这些发现表明,无论是在传统的新辅助治疗中,还是在现代的保留器官治疗方案中,都需要对放疗的使用进行严格的重新评估。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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