Quality of life is an important factor in the indication in patients with advanced pancreatic carcinoma - a prospective multicentric study
Authors:
M. Ryska 1; L. Dušek 2; Radek Pohnán 1
; B. Bunganič 3; L. Bieberová 1; O. Ryska 1; M. Loveček 4; B. Jon 5; K. Rupert 6; M. Krejčí 7; J. Jarkovský 2
Authors place of work:
Chirurgická klinika 2. LF UK a ÚVN Praha, přednosta: prof. MUDr. Miroslav Ryska, CSc.
1; Institut biostatistiky a analýz MU, Brno, ředitel: Doc. RNDr. Ladislav Dušek, CSc.
2; Interní klinika 1. LF UK a ÚVN Praha, přednosta: Prof. MUDr. Miroslav Zavoral, Ph. D.
3; Chirurgická klinika LF UP, Olomouc, přednosta: Doc. MUDr. Čestmír Neoral, CSc.
4; Chirurgická klinika LF UK, Hradec Králové, přednosta: Prof. MUDr. Alexander Ferko, CSc.
5; Chirurgická klinika LF UK, Plzeň, přednosta: Prof. MUDr. Vladislav Třeška, DrSc.
6; Chirurgická klinika 2. LF UK, přednosta: Prof. MUDr. Jiří Hoch, CSc.
7
Published in the journal:
Rozhl. Chir., 2012, roč. 91, č. 4, s. 199-208.
Category:
Original articles
Summary
Introduction:
The aim of this report is to present results of prospective multicentric study on quality of life (QoL) in advanced ductal pancreatic adenocarcinoma patients.
Material and method:
In 426 patients with advanced ductal pancreatic adenocarcinoma, the following parameters were studied: type of treatment, complication rates, 1,2 and 3-year survival rates. QoL was assessed in 151 patients, using a generic SF-36 questionnaire prior the therapy and then 3 months after the treatment. Arithmetic mean and standard deviation (SD) were used for the QoL pool analysis. The results were evaluated using SF-36 software, t-test for independent samples, ANOVA, paired t-test and SPSS 19.0.1 (IBM Corporation, 2010). The p value <0.05 was considered as statistically significant.
Results:
There was a significant difference in the median, 1,2 and 3- year survival rates in the patients with stage III pancreatic cancer who underwent radical resection (RR) compared to the paliative therapy patients (p < 0.001). The highest initial overal QoL value was observed in 39 stage III patients who underwent RR (60.5 ± 1.84) and no significant decrease in this value was recorded over a 3-month postoperative period (difference-5.1 ± 16.6, p= 0.064). Paliative therapy resulted in significant reduction in the overall QoL value(p = 0.020). In the paliative therapy group of patients, BDA resulted in significant reduction in the overall QoL value 3 months after the procedure (p=0.017 vs. ns.). In the group of stage IV patients, nonsignificant increase in the overall QoL value was recorded in 8 patients 3 months after BDA (46.4 ± 17.0 vs. 51.1 ± 9.5 p=0.525). Nonsignificant increase in the overal QoL values was also observed in 18 patients after stent introduction (30.6 ± 8.3 vs. 31.5 ± 8.5 p=0.783). Nonsignificant deterioration in QoL was recorded in patients undergoing exploration, whose initial QoL values corresponded with those in RR patients, while 3 months after the explorative surgery their QoL values were similar to those recorded in the stent group patients (62.0 ± 16.1vs. 41.7 ± 23.6 s rozdílem -20.3 ± 16.2 p<0.001).
Conclusion:
Based on the results of the multicentric prospective study in patients with locally advanced stage III and IV ductal pancreatic adenocarcinoma, the following conclusions can be presented:
- - median and 1,2 and 3-year survival rates in stage III patients were significantly higher in the RR group compared to the paliative therapy patients,
- – initial QoL in stage III patients was significantly the highest in patients who underwent RR. Significant decrease in QoL was recorded in BDA patients. Paliative stent introduction resulted in nonsignificant improvement in the QoL 3 months after the procedure, while the initial QoL values were the lowest in this group,
- – QoL assessment in stage IV patients showed statistically nonsignificant improvement after BDA or stent procedures, the most significant deterioration was observed in the exploration group,
- – no complication which would result in prolongation of the respective hospitalization times was recorded in 67%,
- – early postoperative complications did not result in significant QoL deterioration 3 months after the procedure,
- – absence of chemotherapy results in significant decrease in QoL .
Key words:
pancreatic carcinoma – radical resection – paliative procedure – quality of life
Zdroje
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