背景:皮肤鳞状细胞癌是第二常见的皮肤恶性肿瘤,常见于老年患者和头颈部(cSCCHN)。年龄,预期寿命,目前的指导方针没有考虑到脆弱。
目的:本研究的目的是评估虚弱和预期寿命对指南偏差的影响,治疗结果,cSCCHN患者治疗后的生活质量(QoL)。
方法:前瞻性纳入cSCCHN患者。进行了老年评估,包括老年病8(G8),格罗宁根脆弱指示器,和定时和去测试(TUG)。Lee指数被用来预测有限的预期寿命,成人合并症评估-27被用作合并症指数。在三个时间点通过基底细胞癌和鳞状细胞癌生活质量(BaSQoL)问卷评估QoL。
结果:纳入77例cSCCHN患者。虚弱患者的高危肿瘤明显增多。指南偏差发生率为7.8%,在体弱者(G8)中更为常见,高危肿瘤(≥T2),具有有限的预期寿命或增加的TUG。在我们的研究中,指南偏差并没有导致更多的疾病进展。未发现术后并发症的预测因素。BaSQoL子评分在每个时间点都很低,并且在整个组中随时间没有显着变化。虚弱的患者在治疗后3个月报告更害怕复发或新的肿瘤,治疗后6个月对其他人皮肤的关注较少,与非虚弱患者相比。并发症发生率,性别,或指南偏差不影响任何子量表评分。
结论:评估虚弱和预期寿命可以指导医生和患者做出治疗决定。在预期寿命有限的虚弱患者中,可以考虑偏离指南,偏向于不那么积极的治疗方案。因为在我们的研究中,它对cSCCHN患者的短期结局或QoL没有负面影响.然而,这些结果应该得到其他人的证实,更大的前瞻性研究,随访时间更长。
BACKGROUND: Cutaneous squamous cell carcinoma is the second most common malignancy of the skin, often occurring in older patients and in the head and neck area (cSCCHN). Age, life expectancy, and frailty are not taken into consideration by current
guidelines.
OBJECTIVE: The objective of this study was to evaluate the influence of frailty and life expectancy on guideline deviation, treatment outcomes, and quality of life (QoL) after treatment in patients with cSCCHN.
METHODS: Patients with cSCCHN were prospectively included. A geriatric assessment was performed, including the Geriatric 8 (G8), Groningen Frailty Indicator, and Timed Up and Go test (TUG). The Lee index was used to predict a limited life expectancy, and the Adult Comorbidity Evaluation-27 was used as a comorbidity index. QoL was assessed by the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire at three time points.
RESULTS: Seventy-seven patients with cSCCHN were included. Frail patients had significantly more high-risk tumours.
Guideline deviation occurred in 7.8% and was more common in patients who were frail (G8), with high-risk tumours (≥T2), with a limited life expectancy or an increased TUG.
Guideline deviation did not lead more often to progression of disease in our study. No predictors for post-operative complications were found. BaSQoL subscores were very low at each time point and did not change significantly with time in the total group. Frail patients reported more fear of recurrence or new tumours 3 months after treatment, and less concern about other people\'s skin 6 months after treatment, compared to non-frail patients. Complication rate, gender, or
guideline deviation did not affect any subscale scores.
CONCLUSIONS: Assessment of frailty and life expectancy can guide physicians and patients in treatment decisions. Deviation from
guidelines towards less aggressive treatment schedules can be considered in frail patients with a limited life expectancy, since it did not negatively affect short-term outcomes or QoL in patients with cSCCHN in our study. However, these results should be confirmed by other, larger prospective studies with a longer follow-up period.