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Treatment delays in surgically managed sinonasal cancer and association with survival.

手术治疗鼻腔鼻窦癌的治疗延迟及与生存的关系。

  • 影响因子:2.32
  • DOI:10.1002/lary.27892
  • 作者列表:"Goel AN","Lee JT","Wang MB","Suh JD
  • 发表时间:2020-01-01
Abstract

OBJECTIVE:To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival. STUDY DESIGN:Retrospective cohort study. METHODS:We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression. RESULTS:Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates. CONCLUSION:Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation. LEVEL OF EVIDENCE:NA Laryngoscope, 130:2-11, 2020.

摘要

目的: 描述手术和辅助放疗治疗鼻腔鼻窦肿瘤的治疗延迟,并确定对生存的相关影响。 研究设计: 回顾性队列研究。 方法: 我们在国家癌症数据库中确定了 2004 年至 2014 年因鼻腔鼻窦鳞状细胞癌接受确定性手术和辅助放疗的成年人。然后我们检查了诊断到手术 (DTS) 、手术到辐射 (SRT) 和辐射持续时间 (RTD) 的间隔时间。接下来,我们进行了递归分区分析 (RPA),以确定这些估计生存率最大差异的治疗间隔的阈值。我们使用Cox比例风险回归确定了治疗延迟与总生存期的相关性。 结果: 在纳入的 2,267 例患者中,DTS、SRT和RTD的中位持续时间分别为 32 、 49 和 47 天。治疗延迟的预测因素包括护理过渡、黑人种族和医疗保险。我们确定了DTS、SRT和RTD的阈值分别为 26 、 64 和 51 天,作为估计最大生存差异的阈值。SRT (风险比 [HR] 1.20; 95% 置信区间 [CI],1.03-1.40) 和RTD的延迟 (HR,1.27; 95% CI,1.10-1.46) 超过这些阈值可独立预测死亡率。校正其他协变量后,DTS延迟超过RPA衍生阈值与死亡率无显著相关性。 结论: SRT和RTD间期延迟与总生存期下降相关。中位持续时间可作为国家基准。治疗延迟可以被认为是经手术和辅助放疗治疗的鼻腔鼻窦肿瘤的质量指标。 证据级别: NA喉镜,130:2-11,2 0。

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DOI:10.1002/lary.27849
作者列表:["Tyler MA","Mohamed ASR","Smith JB","Aymard JM","Fuller CD","Phan J","Frank SJ","Ferrarotto R","Kupferman ME","Hanna EY","Gunn GB","Su SY"]

METHODS:OBJECTIVE:To evaluate long-term global and site-specific health-related quality of life (HRQoL) in patients treated for sinonasal and nasopharyngeal malignancies. STUDY DESIGN:Cross-sectional. METHODS:One hundred fourteen patients with sinonasal and nasopharyngeal malignancies received surgery, radiation, systemic chemotherapy, or a combination thereof, with curative intent. Validated global ([EuroQol-5D] Visual Analogue Scale [EQ-5D VAS]) and disease-specific instruments (MD Anderson Symptom Inventory-Head and Neck [MDASI-HN], Anterior Skull Base Questionnaire [ASBQ]) were administered to patients who were both free of disease and had completed treatment at least 12 months previously. Associations between instruments, instrument domains, and specific clinical parameters were analyzed. RESULTS:The median age was 55 years. The mean EQ-5D VAS, MDASI-22 composite score, and ASBQ score were 74 (standard deviation [SD] 21), 48 (SD 36), and 130 (SD 27), respectively. The most frequently reported high-severity items in MDASI-HN were dry mouth and difficulty tasting food. The most frequently reported high-severity items in ASBQ were difficulty with smell and nasal secretions. Advanced Tumor (T) classification was associated with worse overall ASBQ sum score (P = 0.02). ASBQ performance at home and MDASI-HN drowsy symptom items independently predicted worse global HRQoL as measured by the EQ-5D VAS (P < 0.001). CONCLUSION:Global HRQoL for survivors of sinonasal and nasopharyngeal malignancies after multimodality treatment approximates that of the U.S. population for the same age group. ASBQ and MDASI-HN correlate well with global HRQoL outcomes as measured by EQ-5D VAS. MDASI-HN and ASBQ elicited unique symptoms, highlighting the complex symptom burden experienced by these patients. Further studies should identify patients predisposed to reduced long-term QOL. LEVEL OF EVIDENCE:3 Laryngoscope, 130:86-93, 2020.

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影响因子:0.81
发表时间:2020-01-01
来源期刊:Pulmonology
DOI:10.1016/j.pulmoe.2018.10.009
作者列表:["Todo-Bom A","Braido F","Molinengo G","Loureiro C","Canonica GW","Baiardini I"]

METHODS:BACKGROUND:Allergic rhinitis (AR) and asthma are two common chronic diseases that often coexist. There is a need for a validated tool to evaluate HRQoL of Portuguese speakers with asthma and/or rhinitis patients in clinical practice. OBJECTIVES:To adapt and validate RhinAsthma Patient Perspective (RAPP) in Portuguese. METHODS:The RAPP questionnaire was translated into Portuguese. Asthmatics with comorbidities and rhinitis attending the allergy department of Coimbra University Hospital were asked to complete the Portuguese translation of RAPP, in addition to the SF-12, ACT, and a Symptomatologic VAS twice, with a 4-week interval between visits. During Visit 2, a Global Rating Scale (GRS) was completed to assess any change in health status. Scale dimensions, internal consistency and convergent validity, reliability, discriminant ability and responsiveness to change, as well as Minimal Clinical Difference were assessed. RESULTS:Factor and confirmatory analysis confirm the unidimensional structure of the questionnaire. Internal consistency has been shown to be satisfactory (0.82 visit 1 and 0.86 at visit 2). The tool is able to discriminate between patients on the basis of asthma severity, asthma control level, and rhinitis severity; convergent validity showed a significant correlation with SF-2 Physical component (r=-0.46 and 0.42, p at Visits 1 and 2). An ICC of 0.97 and a CCC=0.94 indicate that the tool is highly reliable. Responsiveness was shown in detecting a significant association with GRS changes (r=0.41, p<0.01) and ACT (r=-0.47, p<0.01) but not with VAS. (r=.14, n.s.). MID value was 2 points. CONCLUSIONS:The Portuguese version of RAPP has been demonstrated to have good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice.

翻译标题与摘要 下载文献
影响因子:2.32
发表时间:2020-01-01
来源期刊:The Laryngoscope
DOI:10.1002/lary.27892
作者列表:["Goel AN","Lee JT","Wang MB","Suh JD"]

METHODS:OBJECTIVE:To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival. STUDY DESIGN:Retrospective cohort study. METHODS:We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression. RESULTS:Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates. CONCLUSION:Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation. LEVEL OF EVIDENCE:NA Laryngoscope, 130:2-11, 2020.

翻译标题与摘要 下载文献
鼻部疾病方向

鼻疾病包括外鼻、鼻前庭、鼻腔和鼻窦的疾病可分为感染、出血、变态反应、肿瘤、外伤、异物、先天性畸形和结构异常等。

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