Abstract：
OBJECTIVE: To characterize the pattern of post-treatment quality of life (QoL) for esophageal cancer (EC) survivors and construct models predicting their long-term QoL.
METHODS: On the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants.
RESULTS: The post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year).
CONCLUSIONS: This community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.
METHODS: On the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants.
RESULTS: The post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year).
CONCLUSIONS: This community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.
摘要：
目的：表征食管癌（EC）幸存者治疗后生活质量（QoL）的模式，并构建预测其长期QoL的模型。
方法：在中国欧共体高危地区的一项随机试验的基础上，我们采访了363名欧共体幸存者和25,245名与幸存者年龄相匹配的永久居民，性别,以乡镇为基准。使用三级版本的欧洲生活质量5维仪器测量QoL。我们构建了分段混合模型，估计不同年龄的EC幸存者的QoL，性别,患者类型,医院级别,和治疗以确定QoL决定因素。
结果：与基线相比，EC幸存者的治疗后QoL在第一年内下降了15.7％，在1至9年内恢复了9.3％。发现治疗是QoL的决定因素，并相应地拟合了一系列治疗特定的模型，都呈现出快速下降和逐渐恢复的模式。与食管切除术（1年内下降12.2%）和放化疗（2年内下降37.8%）相比，内镜治疗对治疗后QoL的影响最小（5年内下降7.5%）。在这些患者中，通常的活动维度显示出最大的损害（1年内下降34.4％）。
结论：这项基于社区的研究描述了不同治疗方式后EC幸存者的长期QoL轨迹，并构建了模型来预测治疗后不同时间点的治疗特异性QoL。它从QoL保护的角度为治疗EC的决策提供了新的见解，为估计质量调整寿命年提供了一个方便的工具。
方法：在中国欧共体高危地区的一项随机试验的基础上，我们采访了363名欧共体幸存者和25,245名与幸存者年龄相匹配的永久居民，性别,以乡镇为基准。使用三级版本的欧洲生活质量5维仪器测量QoL。我们构建了分段混合模型，估计不同年龄的EC幸存者的QoL，性别,患者类型,医院级别,和治疗以确定QoL决定因素。
结果：与基线相比，EC幸存者的治疗后QoL在第一年内下降了15.7％，在1至9年内恢复了9.3％。发现治疗是QoL的决定因素，并相应地拟合了一系列治疗特定的模型，都呈现出快速下降和逐渐恢复的模式。与食管切除术（1年内下降12.2%）和放化疗（2年内下降37.8%）相比，内镜治疗对治疗后QoL的影响最小（5年内下降7.5%）。在这些患者中，通常的活动维度显示出最大的损害（1年内下降34.4％）。
结论：这项基于社区的研究描述了不同治疗方式后EC幸存者的长期QoL轨迹，并构建了模型来预测治疗后不同时间点的治疗特异性QoL。它从QoL保护的角度为治疗EC的决策提供了新的见解，为估计质量调整寿命年提供了一个方便的工具。
