目的:鼻窦恶性肿瘤(SNMs)对患者的生活质量(QOL)有不利影响,通常在晚期被发现。因为这些肿瘤很罕见,很少有研究检查受影响的特定QOL领域。这些知识将有助于改善这些患者的护理。
方法:在此前瞻性中,多机构研究,对273例接受有治愈意图的明确治疗的SNM患者进行了评估。我们使用华盛顿大学的生活质量(UWQOL)仪器超过5年的诊断,以确定人口统计学,治疗,以及从基线到治疗后5年影响12个UWQOL子域的疾病相关因素。
结果:多变量模型发现内镜切除术可改善疼痛(与非手术治疗CI2.4,19.4,p=0.01)和外观与开放(CI27.0,35.0,p<0.001)或联合(CI10.4,17.1,p<0.001)。翼腭窝受累预测吞咽恶化(CI-10.8,-2.4,p=0.01)和疼痛(CI-17.0,-4.0,p<0.001)。颈淋巴结清扫术预测吞咽不良(CI-14.8,-2.8,p<0.001),味道(CI-31.7,-1.5,p=0.02),和唾液症状(CI-28.4,-8.6,p<0.001)。相对于其他部位,上颌受累预测咀嚼(CI9.8,33.2;p<0.001)和言语(CI-21.8,-5.4,p<0.001)较差。晚期T期预测焦虑更差(CI-13.0,-2.0,p=0.03)。
结论:手术入路,宫颈疾病的管理,肿瘤范围,受累部位影响可变的UWQOL症状区域。内镜切除预测疼痛更好,外观,和咀嚼相比开放。这些结果可能有助于就SNM治疗和康复过程中的潜在QOL期望向患者提供咨询。
OBJECTIVE: Sinonasal malignancies (SNMs) adversely impact patients\' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients.
METHODS: In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment.
RESULTS: Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p = 0.01) and appearance versus open (CI 27.0, 35.0, p < 0.001) or combined (CI 10.4, 17.1, p < 0.001). Pterygopalatine fossa involvement predicted worse swallow (CI -10.8, -2.4, p = 0.01) and pain (CI -17.0, -4.0, p < 0.001). Neck dissection predicted worse swallow (CI -14.8, -2.8, p < 0.001), taste (CI -31.7, -1.5, p = 0.02), and salivary symptoms (CI -28.4, -8.6, p < 0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p < 0.001) and speech (CI -21.8, -5.4, p < 0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI -13.0, -2.0, p = 0.03).
CONCLUSIONS: Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.