Quality of life following endoscopic endonasal resection of anterior skull base cancers

Clinical article

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Object

For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection.

Methods

The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy.

Results

One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05).

Conclusions

Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.

Abbreviations used in this paper:ASBS-Q = Anterior Skull Base Surgery Questionnaire; CHT = chemotherapy or radiochemotherapy; ER = endoscopic resection; ERTC = ER with transnasal craniectomy; QOL = quality of life; RT = radiotherapy; T0 = no postoperative therapy.

Article Information

Address correspondence to: Mario Turri-Zanoni, M.D., Department of Otorhinolaryngology, University of Insubria, 9 Via Guicciardini, Varese, Italy. email: tzmario@inwind.it.

Please include this information when citing this paper: published online September 20, 2013; DOI: 10.3171/2013.8.JNS13296.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Selection criteria for the population enrolled in the study. CER = cranioendoscopic resection; DOD = died of disease.

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    A: Median values of overall QOL for all enrolled patients for each period tested. The 3 values were statistically different (p < 0.05). B: Radar chart depicting the median values of the QOL domains in the different periods tested. Pre-op = preoperative period; 1M = 1-month postoperative period; 1Y = 1-year postoperative period.

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    The trend of overall QOL during the different periods tested, analyzed by stratifying the population according to age (A), sex (B), surgical approach (C), adjuvant therapy (D), and T classification of disease (E). PRE = preoperative period.

  • View in gallery

    Radar charts of QOL domains during the different periods tested, stratifying the population according to age (A–C), surgical approach (D–F), and adjuvant therapy (G–I). Comparisons between these subgroups are reported only for the most significant periods (C, F, and I).

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