Introduction
Methods
Patients’ background
Scoring of QOL-ACD-BP
Physical aspects
| |
1. | Did you care about pain or numbness caused by disease or treatment? |
2. | Did you care about swelling caused by disease or treatment? |
3. | Did you care about the skin symptoms (redness, swelling, hotness, itching, hair loss, etc.) caused by disease or treatment? |
4. | Did you care about the dietary symptoms (food amount decreased, taste changed, body weight changed, etc.)? |
5. | Did you feel disturbing, tired, or insomnia? |
6. | Did you have any other concerns in your body (headache, breathlessness, palpitations, eye irritation, etc)? |
Emotional aspects
| |
7. | Were you satisfied with the explanation from medical staff (your doctor, nurse, pharmacist, etc.) about the medical condition and treatment? |
8. | Do you mind the progress of the current disease and the effect of treatment? |
9. | Do you feel uneasy about side effects, future complications, and body changes? |
10. | Have you fully accepted your disease? |
11. | Have you tried to face up to the disease positively? |
12. | Do you feel uneasy about future (treatment period, whether it will be cured or not, whether it comes to life or not)? |
Social aspects
| |
13. | Do you feel hesitant to dressing or hesitation for being naked in public in hot springs? |
14. | Do you feel uneasy about balancing housework, work and treatment? |
15. | Do you feel uneasy about cost? |
16. | Are you satisfied with sex life? |
17 | Are you worried that your family will get the same disease? |
18. | Do you feel a sense of alienation, loneliness, and discrimination from the surroundings? |
Evaluation of QOL-ACD-BP
Ethics
Statistical analysis
Results
Correlations between clinicopathological features and QOL-ACD-BP
Parameters (n = 300) | Number of patients (%) |
---|---|
Age (years old) | |
≤ 35/36–55/56–70/71 ≤ | 36 (12.0%)/120 (40.0%)/127 (42.3%)/17 (5.7%) |
Tumor size (mm) | |
≤ 20/20 <, ≤ 50/50 ≤ | 35 (11.7%)/ 224 (74.7%)/ 41 (13.7%) |
Skin infiltration | |
Negative/positive | 262 (87.3%)/ 38 (12.7%) |
Lymph node metastasis | |
N0/N1/N2/N3 | 90 (30.0%)/116 (38.6%)/65 (21.7%)/29 (9.7%) |
Estrogen receptor | |
Negative/positive | 155 (51.7%)/145 (48.3%) |
Progesterone receptor | |
Negative/positive | 200 (66.7%)/100 (33.3%) |
HER2 | |
Negative/positive | 212 (70.7%)/88 (29.3%) |
Ki67 | |
Low/high | 96 (32.0%)/204 (68.0%) |
Intrinsic subtype | |
HRBC/HER2BC/TNBC | 149 (49.7%)/57 (19.0%)/94 (31.3%) |
ORR | |
Non-responders/responders | 32 (10.7%)/268 (89.3%) |
pCR | |
Negative/positive | 201 (67.0%)/99 (33.0%) |
Reccurence | |
Negative/positive | 238 (79.3%)/62 (20.7%) |
Death from breast cancer | |
Negative/positive | 270 (90.0%)/30 (10.0%) |
QOL-ACD-BP before neoadjuvant chemotherapy | |
Low/high | 115 (38.3%)/185 (61.7%) |
Change of QOL from before POC to after POC | |
The lower change/the higher change | 47 (15.7%)/253 (84.3%) |
QOL-ACD-BP after neoadjuvant chemotherapy | |
Low/high | 72 (24.0%)/228 (76.0%) |
Parameters | QOL-ACD-B before POC | p value | Change of QOL | p value | QOL-ACD-B after POC | p value | ||||
---|---|---|---|---|---|---|---|---|---|---|
High (n = 185) | Low (n = 115) | Higher (n = 253) | Lower (n = 47) | High (n = 228) | Low (n = 72) | |||||
Age at operation (years) | ||||||||||
≤ 55 > 55 | 93 (50.3%) 92 (49.7%) | 63 (54.7%) 52 (45.3%) | 0.449 | 137 (54.2%) 116 (45.8%) | 19 (40.4%) 28 (59.6%) | 0.084 | 123 (53.9%) 105 (46.1%) | 33 (45.8%) 39 (54.2%) | 0.231 | |
Tumor size (mm) | ||||||||||
≤ 50 > 50 | 174 (94.1%) 11 (6.0%) | 85 (73.9%) 30 (26.1%) | < 0.001 | 219 (86.6%) 34 (13.4%) | 40 (85.1%) 7 (14.9%) | 0.791 | 202 (88.6%) 26 (11.4%) | 57 (79.2%) 15 (20.8%) | 0.042 | |
Skin infiltration | ||||||||||
Negative Positive | 178 (96.2%) 7 (3.8%) | 84 (73.0%) 31 (27.0%) | < 0.001 | 220 (87.0%) 33 (13.0%) | 42 (89.4%) 5 (10.6%) | 0.650 | 203 (89.0%) 25 (11.0%) | 59 (81.9%) 13 (18.1%) | 0.116 | |
Lymph node status | ||||||||||
Negative Positive | 62 (33.5%) 123 (66.5%) | 28 (24.3%) 87 (75.7%) | 0.093 | 73 (28.9%) 180 (71.1%) | 17 (36.2%) 30 (63.8%) | 0.316 | 65 (28.5%) 163 (71.5%) | 25 (34.7%) 47 (65.3%) | 0.318 | |
Estrogen receptor | ||||||||||
Negative Positive | 99 (53.5%) 86 (46.5%) | 56 (48.7%) 59 (51.3%) | 0.419 | 123 (48.6%) 130 (51.4%) | 32 (68.1%) 15 (31.9%) | 0.014 | 112 (49.1%) 116 (50.9%) | 43 (59.7%) 29 (40.3%) | 0.117 | |
Progesterone receptor | ||||||||||
Negative Positive | 132 (71.4%) 53 (28.6%) | 68 (59.1%) 47 (40.9%) | 0.029 | 163 (64.4%) 90 (35.6%) | 37 (78.7%) 10 (21.3%) | 0.057 | 147 (64.5%) 81 (35.5%) | 53 (73.6%) 19 (26.4%) | 0.153 | |
HER2 | ||||||||||
Negative Positive | 131 (70.8%) 54 (29.2%) | 81 (70.4%) 34 (29.6%) | 0.945 | 176 (69.6%) 77 (30.4%) | 36 (76.6%) 11 (23.4%) | 0.333 | 160 (70.2%) 68 (29.8%) | 52 (72.2%) 20 (27.8%) | 0.741 | |
Ki67 | ||||||||||
Low High | 61 (33.0%) 124 (67.0%) | 35 (30.4%) 80 (69.6%) | 0.648 | 80 (31.6%) 173 (68.4%) | 16 (34.0%) 31 (66.0%) | 0.745 | 76 (33.3%) 152 (66.7%) | 20 (27.8%) 52 (72.2%) | 0.380 | |
Intrinsic subtype HRBC | ||||||||||
No Yes | 96 (51.9%) 89 (48.1%) | 55 (47.8%) 60 (52.2%) | 0.495 | 119 (47.0%) 134 (53.0%) | 32 (68.1%) 15 (31.9%) | 0.008 | 109 (47.8%) 119 (52.2%) | 42 (58.3%) 30 (41.7%) | 0.120 | |
Intrinsic subtype HER2BC | ||||||||||
No Yes | 149 (80.5%) 36 (19.5%) | 94 (81.7%) 21 (18.3%) | 0.798 | 204 (80.6%) 49 (19.4%) | 39 (83.0%) 8 (17.0%) | 0.708 | 185 (81.1%) 43 (18.9%) | 58 (80.6%) 14 (19.4%) | 0.913 | |
Intrinsic subtype TNBC | ||||||||||
No Yes | 125 (67.6%) 60 (32.4%) | 81 (70.4%) 34 (29.6%) | 0.604 | 183 (72.3%) 70 (27.7%) | 23 (48.9%) 24 (51.1%) | 0.001 | 162 (71.1%) 66 (28.9%) | 44 (61.1%) 28 (38.9%) | 0.114 | |
ORR | ||||||||||
Non-responders Responders | 18 (9.7%) 167 (90.3%) | 14 (12.2%) 101 (87.8%) | 0.507 | 23 (9.1%) 230 (90.9%) | 9 (19.1%) 38 (80.9%) | 0.040 | 19 (8.3%) 209 (91.7%) | 13 (18.1%) 59 (81.9%) | 0.020 | |
Pathological response | ||||||||||
Non-pCR pCR | 117 (63.2%) 68 (36.8%) | 84 (73.0%) 31 (27.0%) | 0.080 | 171 (67.6%) 82 (32.4%) | 30 (63.8%) 17 (36.2%) | 0.616 | 149 (65.4%) 79 (34.6%) | 52 (72.2%) 20 (27.8%) | 0.281 | |
QOL before POC | ||||||||||
Low High | – – | – – | 108 (42.7%) 145 (57.3%) | 7 (14.9%) 40 (85.1%) | < 0.001 | 91 (39.9%) 137 (60.1%) | 24 (33.3%) 48 (66.7%) | 0.319 | ||
Change of QOL | ||||||||||
The lower change The higher change | 40 (21.6%) 145 (78.4%) | 7 (6.1%) 108 (93.9%) | < 0.001 | – – | – – | 4 (1.8%) 224 (98.2%) | 43 (59.7%) 29 (40.3%) | < 0.001 | ||
QOL after POC | ||||||||||
Low High | 48 (25.9%) 137 (74.1%) | 24 (20.9%) 91 (79.1%) | 0.319 | 29 (11.5%) 224 (88.5%) | 43 (91.5%) 4 (8.5%) | < 0.001 | – – | – – |
Correlation between each QOL and prognosis
Parameters | Univarite analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
Hazard ratio | 95% CI | p value | Hazard ratio | 95% CI | p value | |
Age at operation (years) | ||||||
≤ 55 | 0.693 | 0.414–1.143 | 0.151 | |||
> 55 | ||||||
Tumor size (mm) | ||||||
≤ 50 | 2.882 | 1.602–4.948 | 0.001 | 1.730 | 0.867–3.299 | 0.117 |
> 50 | ||||||
Skin infiltration | ||||||
Negative | 2.034 | 1.056–3.646 | 0.035 | 1.162 | 0.530–2.425 | 0.700 |
Positive | ||||||
Lymph node status | ||||||
Negative | 2.426 | 1.259–5.268 | 0.007 | 2.816 | 1.398–6.315 | 0.003 |
Positive | ||||||
Estrogen receptor | ||||||
Negative | 0.751 | 0.451–1.238 | 0.262 | |||
Positive | ||||||
Progesterone receptor | ||||||
Negative | 0.928 | 0.539–1.553 | 0.781 | |||
Positive | ||||||
HER2 | ||||||
Negative | 0.586 | 0.298–1.063 | 0.080 | |||
Positive | ||||||
Ki67 | ||||||
Low | 0.944 | 0.563–1.629 | 0.830 | |||
High | ||||||
Intrinsic subtype HRBC | ||||||
No | 0.757 | 0.456–1.27 | 0.274 | |||
Yes | ||||||
Intrinsic subtype HER2BC | ||||||
No | 0.836 | 0.400–1.574 | 0.597 | |||
Yes | ||||||
Intrinsic subtype TNBC | ||||||
No | 1.532 | 0.907–2.539 | 0.109 | |||
Yes | ||||||
ORR | ||||||
Non-responders | 0.265 | 0.151–0.492 | < 0.001 | 0.275 | 0.146–0.540 | < 0.001 |
Responders | ||||||
Pathological response | ||||||
Non-pCR | 0.438 | 0.222–0.795 | 0.006 | 0.578 | 0.284–1.099 | 0.097 |
pCR | ||||||
QOL-ACD-BP before POC | ||||||
Low | 0.522 | 0.316–0.863 | 0.012 | 0.571 | 0.319–1.036 | 0.065 |
High | ||||||
Change of QOL between POC | ||||||
Lower change | 0.380 | 0.223–0.675 | 0.001 | 0.557 | 0.243–1.222 | 0.146 |
Higher change | ||||||
QOL-ACD-BP after POC | ||||||
Low | 0.941 | 0.923–0.962 | < 0.001 | 0.469 | 0.234–1.011 | 0.053 |
High |
Parameters | Univarite analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
Hazard ratio | 95% CI | p value | Hazard ratio | 95% CI | p value | |
Age at operation (years) | ||||||
≤ 55 | 0.664 | 0.311–1.367 | 0.268 | |||
> 55 | ||||||
Tumor size (mm) | ||||||
≤ 50 | 2.563 | 1.070–5.537 | 0.036 | 1.318 | 0.484–3.341 | 0.576 |
> 50 | ||||||
Skin infiltration | ||||||
Negative | 2.233 | 0.883–4.969 | 0.086 | |||
Positive | ||||||
Lymph node status | ||||||
Negative | 3.299 | 1.164–13.822 | 0.022 | 3.490 | 1.093–15.795 | 0.034 |
Positive | ||||||
Estrogen receptor | ||||||
Negative | 0.477 | 0.213–1.000 | 0.050 | |||
Positive | ||||||
Progesterone receptor | ||||||
Negative | 0.881 | 0.394–1.843 | 0.742 | |||
Positive | ||||||
HER2 | ||||||
Negative | 0.29 | 0.069–0.822 | 0.017 | 0.472 | 0.105–1.566 | 0.233 |
Positive | ||||||
Ki67 | ||||||
Low | 1.430 | 0.662–3.427 | 0.374 | |||
High | ||||||
Intrinsic subtype HRBC | ||||||
No | 0.513 | 0.233–1.071 | 0.076 | |||
Yes | ||||||
Intrinsic subtype HER2BC | ||||||
No | 0.498 | 0.119–1.417 | 0.210 | |||
Yes | ||||||
Intrinsic subtype TNBC | ||||||
No | 2.850 | 1.372–6.028 | 0.005 | 2.776 | 1.174–6.871 | 0.020 |
Yes | ||||||
ORR | ||||||
Non-responders | 0.227 | 0.103–0.548 | 0.002 | 0.199 | 0.080–0.522 | 0.002 |
Responders | ||||||
Pathological response | ||||||
Non-pCR | 0.376 | 0.127–0.905 | 0.028 | 0.441 | 0.142–1.146 | 0.095 |
pCR | ||||||
QOL-ACD-BP before POC | ||||||
Low | 0.478 | 0.230–0.982 | 0.045 | 0.441 | 0.196–0.992 | 0.048 |
High | ||||||
Change of QOL between POC | ||||||
Lower change | 0.432 | 0.199–1.039 | 0.060 | 1.225 | 0.345–4.078 | 0.744 |
Higher change | ||||||
QOL-ACD-B after POC | ||||||
Low | 0.321 | 0.154–0.678 | 0.004 | 0.273 | 0.098–0.872 | 0.030 |
High |