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Prospective Evaluation of Health-Related Quality of Life in Patients Undergoing Anterolateral Craniofacial Resection with Orbital Exenteration

Mukoyama, Nobuaki Nishio, Naoki Kimura, Hiroyuki Kishi, Shinichi Tokura, Tatsuya Kimura, Hiroki Hiramatsu, Mariko Maruo, Takashi Tsuzuki, Hidenori Fujii, Masazumi Iwami, Kenichiro Takanari, Keisuke Kamei, Yuzuru Ozaki, Norio Sone, Michihiko Fujimoto, Yasushi 名古屋大学

2020.10

概要

Objective: This study was aimed to evaluate health-related quality of life in patients undergoing anterolateral craniofacial resection (AL-CFR) with orbital exenteration (OE) for malignant skull base tumors and to investigate the effects of early psychiatric intervention. Design: Present study is a prospective, observational study. Setting: The study took place at the hospital department. Participants: Twenty-six consecutive patients were selected who underwent AL-CFR with OE at our hospital between 2005 and 2015. Main Outcome Measures: Health-related quality of life was assessed preoperatively and 3, 6, 12, and 24 months after surgery using the Hospital Anxiety and Depression Scale (HADS) and medical outcomes study 8-items Short Form health survey (SF-8). In all cases, psychiatric intervention was organized by the consultation liaison psychiatry team preoperatively and postoperatively. Results: Ten (38.0%) of the 26 patients died and 16 (62.0%) were alive and disease-free at the end of the study. The 3-year overall and disease-free survival rates were 64.9% and 53.3%, respectively. Twenty-one patients (80.8%) developed psychiatric complications after surgery and needed treatment with psychotropic medication. Before surgery, 28% of patients had HADS scores ≥8 for anxiety and 20% had scores ≥8 for depression. Seven of the eight items in the SF-8 were significantly lower than those for the general Japanese population. However, scores for all the SF-8 items gradually improved during postoperative follow-up, reaching approximately 50 points, which is the national standard value, at 2 years after surgery. Conclusions: Craniofacial resection with OE was feasible and well tolerated in patients with malignant skull base tumors who received early psychiatric intervention to decrease the considerable psychological impact of this procedure.

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Figure Captions

Figure 1 Psychiatric assessment and intervention for patients who have undergone anterolateral

craniofacial resection with orbital exenteration at our hospital.

AL-CRF, anterolateral craniofacial resection; HADS, Hospital Anxiety and Depression Scale; ICU, intensive

care unit; OE, with orbital exenteration; SF-8, Medical Outcomes Study 8 Items Short Form Health Survey

Figure 2 Kaplan-Meier survival curves for overall survival (OS) and disease-free survival (DFS) in 26 cases.

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Figure 3 Changes in the Hospital Anxiety and Depression Scale (HADS) score during follow-up.

Dotted line: HADS anxiety and depression scores of 8 (indicating all potential cases)

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Figure 4 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores during

follow-up: A comparison with Japanese population norms.

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Figure 5 Comparison of Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores and

Medical Outcomes Study 8 Items Short Form Health Survey (SF-8) Physical Component Summary (PCS)

and Mental Component Summary (MCS) scores between survivors and non-survivors during follow-up.

*p<0.05

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Table 1 Patient Characteristics

Variable

n (%)

Sex

Male

21 (81)

Female

5 (19)

Primary location

Ethmoid sinus

19 (73)

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Maxillary sinus

Facial skin

T classification

2 (8)

16 (62)

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T4a

1 (4)

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Frontal sinus

4 (15)

T4b

10 (38)

No

14 (54)

Yes

12 (46)

CSF leak, minor

2 (8)

CSF leak, major

4 (15)

Wound, minor

5 (19)

Wound, major

3 (12)

Cerebral infarction

1 (4)

Recurrence

No

14 (54)

Yes

12 (46)

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Complication

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Local recurrence

6 (23)

Regional recurrence

7 (27)

Distant metastasis

2 (8)

Final outcome

Alive without disease

16 (62)

Deceased

10 (38)

CSF, cerebrospinal fluid

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Table 2 Comparison of SF-8 scores in patients who underwent anterolateral craniofacial resection

with orbital exenteration and those in the general Japanese population

SF-8

Assessment time points

item

Preoperativel

3 months

6 months

12 months

24 months

General

Japanese

population

44.4**

43.8**

45.8

45.9***

47.8*

50.7

RP

37.7***

40.6**

45.2

44.7*

49.2

50.9

BP

46.0**

47.9

48.5

50.2

52.9

51.7

GH

45.3**

49.6

50.4

50.5

52.3

51.2

VT

48.4

48.0*

53.6

52.2

52.7

51.7

SF

40.1***

41.8***

45.9

45.7*

46.9

50.0

RE

42.6**

41.1**

47.8

46.4*

51.6

50.9

48.4*

50.0

51.4

50.1

49.2

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MH

Fo

PF

51.0

BP, Bodily Pain; GH, General Health; MH, Mental Health; PF, Physical Function; RE: Role Emotional; RP,

***p<0.001,**p<0.01,*p<0.05

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Role Physical; SF, Social Functioning; VT, Vitality.

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Figure 1

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Figure 2

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Figure 3

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254x190mm (300 x 300 DPI)

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Figure 4

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Figure 5

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254x190mm (300 x 300 DPI)

...

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