胃癌和食管癌术后重返工作及工作状态：一项前瞻性观察研究
Return-To-Work and Working Status After Surgery for Gastric and Esophageal Cancer: A Prospective Observational Study.
作者
作者单位
- Department of Surgery Kyoto University Kyoto Japan.
- Department of Regulatory Science and Pharmaceutical Informatics, School of Pharmaceutical Sciences Wakayama Medical University Wakayama Japan.
- Department of Surgery Osaka Red Cross Hospital Osaka Japan.
- Department of Gastrointestinal Surgery Japanese Red Cross Wakayama Medical Center Wakayama Japan.
- Department of Surgery Kyoto-Katsura Hospital Kyoto Japan.
- Department of Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan.
- Department of Gastrointestinal Surgery Kyoto City Hospital Kyoto Japan.
- Department of Surgery Kobe City Medical Center West Hospital Hyogo Japan.
- Department of Gastrointestinal Surgery Tenri Yorozu Hospital Nara Japan.
- Department of Surgery Japan Baptist Hospital Kyoto Japan.
- Occupational Welfare Division, Agency for Health, Safety and Environment Kyoto University Kyoto Japan.
摘要
中文
随着胃癌和食管癌患者生存率的持续改善，长期工作参与已成为重要的生存结局指标。本研究旨在评估胃癌和食管癌根治性手术后18个月的重返工作（RTW）率，并明确与延迟或未能重返工作相关的临床和社会经济因素。该多中心、纵向、前瞻性队列研究纳入接受胃癌或食管癌根治性手术的工作年龄日本患者，分别于术前及术后6、12、18个月评估工作状态。主要结局为术后18个月的工作状态，次要结局包括首次重返工作时间及与非工作和延迟重返工作相关的因素。探索性分析评估了6个月时患者报告结局（QLQ-C30）及术后体重下降。在158例符合条件的患者中，124例（78.5%）在18个月时仍在工作。高龄（≥65岁）及病理分期≥III期与18个月时未工作相关，而久坐工作及自谋职业与非工作的风险较低相关。术后食欲下降、经济困难（QLQ-C30）及6个月时体重下降≥10%与非工作状态相关。胃癌和食管癌患者首次重返工作的中位时间分别为30天和70天。食管癌及晚期分期始终与延迟重返工作相关，女性及术前退休的证据相对较弱。约80%的患者在术后18个月仍在工作。术后营养功能损害和症状负担与长期工作参与相关，有助于识别术后可能无法重返工作的高危患者。
English
As survival after gastric and esophageal cancer continues to improve, sustained work participation has become an important survivorship outcome. We aimed to evaluate return-to-work (RTW) rates 18 months after curative-intent surgery for gastric and esophageal cancers and to identify clinical and socioeconomic factors associated with delayed or failed RTW. This multicenter, longitudinal, prospective cohort study evaluated working-age Japanese patients undergoing curative-intent surgery for gastric or esophageal cancer. Working status was assessed preoperatively and at 6, 12, and 18 months postoperatively. The primary outcome was working status at 18 months. Secondary outcomes included time to first RTW, and factors associated with non-working and delayed RTW. Exploratory analyses evaluated 6-month patient-reported outcomes (QLQ-C30) and postoperative weight loss. Among 158 eligible patients, 124 (78.5%) were working at 18 months. Older age (≥ 65 years) and pathological stage≥ III were associated with non-working at 18 months, whereas sedentary work and self-employment were associated with a lower risk of non-working. Postoperative appetite loss, financial difficulties (QLQ-C30), and ≥ 10% body weight loss at 6 months were associated with non-working status. Median time to first RTW was 30 and 70 days for gastric and esophageal cancers, respectively. Esophageal cancer and advanced stage were consistently associated with delayed RTW, with weaker evidence for associations with female sex and preoperative retirement. Approximately 80% of patients were working at 18 months after surgery. Postoperative nutritional impairment and symptom burden were associated with long-term work participation and may help identify patients at risk of not working after surgery.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q2
- 影响因子
- 3.2
- 新锐分区
- 2区