131I治疗对早期甲状腺乳头状癌女性患者健康相关生存质量的影响

Impact of 131I treatment on health-related quality of life in female patients with early stage papillary thyroid cancer

    摘要
  • 摘要:
    目的 探讨早期甲状腺乳头状癌（PTC）女性患者接受131I治疗与否对健康相关生存质量（HRQOL）的影响。
    方法 回顾性分析 2015年 6月至 2016年 6月于吉林大学中日联谊医院接受双侧甲状腺全切的 PTC女性患者 356例（患者组），年龄 21~65（41.00±9.64）岁。应用欧洲癌症研究与治疗组织（EORTC）开发的生存质量核心量表30（QLQ-C30）（简称EORTC QLQ-C30）进行HRQOL评估，分别比较 400名与上述患者年龄相匹配21~65（41.70±9.38）岁 的健康女性体检者（对照组）与患者组在EORTC QLQ-C30各领域得分 包括 5个功能领域、9个症状领域以及独立的总体生活质量（GQOL）。根据是否接受过131I治疗将所有患者分为 2组：131I 治疗组（205例）和未治疗组（151例），分别比较 2组患者术前及术后 （1、3、6个月）的促甲状腺激素（TSH）和甲状腺球蛋白（Tg）水平、EORTC QLQ-C30各领域得分。数据的组间比较采用 Mann-Whitney U秩和检验。
    结果 患者组术前的GQOL得分（59.11±21.12）明显低于对照组（83.08±14.62），除了身体功能以外的其他功能领域的得分均低于对照组，除了疼痛以外的其他症状领域的得分均高于对照组，且差异均有统计学意义（Z=−6.958~−4.673，均 P<0.05）。术后 6个月，患者组的 GQOL得分（73.88±18.04）虽然仍低于对照组，但与术前相比有明显提升，除了身体功能、认知功能、社会功能以外的其他功能领域的得分均比术前升高，除了乏力、疼痛、气短以外的其他症状领域的得分均比术前降低，且差异均有统计学意义（Z=−5.790~−2.876，均 P<0.05）。术前131I治疗组与未治疗组的 GQOL及其他所有领域的得分的差异均无统计学意义（Z=−0.876~−0.001，均 P>0.05）。术后 1个月，131I 治疗组的 TSH和 Tg水平明显高于未治疗组，且差异均有统计学意义（Z=−6.159、−10.061，均 P<0.01）；131I治疗组的GQOL得分（50.57±17.72）低于未治疗组（55.74±18.82），功能领域的得分均低于未治疗组，除了疼痛、腹泻、经济困难以外的其他症状领域的得分均高于未治疗组，且差异均有统计学意义（Z=−5.512~−2.550，均 P<0.05）。术后 3个月，131I治疗组的 GQOL得分（64.43±32.12）仍低于未治疗组（72.68±17.29），但131I 治疗组功能领域仅有角色功能、情绪功能、社会功能的得分低于未治疗组，症状领域仅有失眠、食欲下降的得分高于未治疗组，且差异均有统计学意义（Z=−2.939~−0.984，均 P<0.05）。术后 6个月，131I治疗组的 GQOL得分及其他所有领域的得分的差异均无统计学意义（Z=−2.550~−0.008，均 P>0.05）。
    结论 131I治疗不影响早期PTC女性患者术后6个月及以后的HRQOL。

     

    Abstract:
    Objective To analyze the effect of 131I treatment on health-related quality of life (HRQOL) in female patients with early stage thyroid papillary carcinoma (PTC).
    Methods The data of 356 female PTC patients (aged 21−65 (41.00±9.64) years) with pT1N1aM0 in China-Japan Union Hospital of Jilin University collected from June 2015 to June 2016 were retrospectively analyzed. A total of 400 healthy women (aged 21−65 (41.70±9.38) years) were selected as healthy controls. The HRQOL scores by the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-core 30(QLQ-C30) between the controls and PTC patients at preoperative period and at 6 months after the operation were compared. Patients were divided into two groups according to whether or not they received 131I treatment (131I treatment group: n=205, non-131I treatment group: n=151). The levels of thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and HRQOL scores at preoperative period and at 1, 3, and 6 months after the operation were compared between the two groups. Informed consent was obtained from all subjects. Non-parametric test of Mann-Whitney U was used to compare the groups with SPSS 19.0 software.
    Results Before the operation, the global quality of life (GQOL) score of all patients was significantly lower than that of the controls (59.11±21.12 vs. 83.08±14.62), functional domain scores in patients were lower than those in the controls except physical function, symptom domain scores were significantly higher except pain (Z=−6.958 to −4.673, all P<0.05). At 6 months after operation, the GQOL score in patients was still lower than that in the controls (73.88±18.04 vs. 83.08±14.62), but it was significantly higher than the preoperative score. Similar improvements were found in eight other domains other than physical function, cognitive function, social function, fatigue, pain and dyspnoea (Z=−5.790 to −2.876, all P<0.05). No significant difference was found in the preoperative all-domain scores between the 131I and non-131I treatment groups (Z=−0.876 to −0.001, all P>0.05). TSH and Tg in 131I treatment group were significantly higher than non-131I treatment group at 1 month after operation (Z=−6.159, −10.061, both P<0.01). At 1 month after operation, the GQOL score in the 131I treatment group was significantly lower than that in the non-131I treatment group (50.57±17.72 vs. 55.74±18.82). Functional domain scores of the 131I treatment group were significantly lower than those in the non-131I treatment group, symptom domain scores were significantly higher except pain, diarrhea, and financial impact (Z=−5.512 to −2.550, all P<0.05). At 3 months after operation, the GQOL score of the 131I treatment group was still lower than that in the non-131I treatment group (64.43±32.12 vs. 72.68±17.29), but the functional domain scores of the 131I treatment group were lower than that in the non-131I treatment group only in the role function, emotional function, social function, and symptom domain scores were higher only in the insomnia, appetite loss (Z=−2.939 to −0.984, all P<0.05). At 6 months after operation, no difference was found in the GQOL score and any other scores between the 131I treatment group and non-131I treatment group (Z=−2.550 to −0.008, all P>0.05).
    Conclusion 131I treatment had no impact on HRQOL in female patients with early stage PTC at 6 months after the operation or longer.

     

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