Health-related quality of life after risk-reducing hysterectomy (PRESCORES): a cross-sectional study.
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Oxley Samuel George, Lake Milly, Dibden Amanda, Whenham Tia, Wei Xia, Mansour Lea, Kalra Ashwin, Ganesan Subhasheenee, Sia Jacqueline, Sideris Michail, Fierheller Caitlin, Kurzer Margarida, Perfect-Lake Rachel, Pundir Jyotsna, Armstrong Ruth, Balega Janos, Bhatnagar Ishita, Cicchetti Michela, Compton Cecilia, Cook Jacqueline, Davidson Rosemarie, Dawson Lesa, Ghaem-Maghami Sadaf, Hanson Helen, Harrison Rachel, Hart Rachel, Kraus Alison, Lalloo Fiona, Evans D Gareth, McVeigh Terri P, Monahan Kevin, Monje-Garcia Laura, Moss Esther, Murray Alex, Ong Kai Ren, Rawson Myfanwy, Repana Dimitra, Rosenthal Adam N, Ryan Neil, Sarkies Lyndall, Sharif Saba, Side Lucy, Simon Kate, Smith Tracy, Solomons Joyce, Tripathi Vishakha, Watford Amy, Willett Mark, Brentnall Adam, Legood Rosa, Manchanda Ranjit, PRESCORES study team
Аннотация
METHODS: PRESCORES was a multicentre cross-sectional study (ISRCTN17432105). We invited 4031 UK women ≥18 years with confirmed Lynch Syndrome, without prior gynaecological cancer, to participate between May 2023 and November 2024. The main outcome was a complete-case adjusted mean-difference in EQ-5D utility scores between participants who had undergone RRH or not, and by pre/post-menopausal age groups. Quality-of-life was measured at the time of survey completion, and retrospectively 4 months after surgery in the RRH-group. The Cancer-Worry Scale instrument was also evaluated by RRH group. Sensitivity analysis considered alternative statistical methods, multiple imputation, and restricting analysis to people 35-80 years.
FINDINGS: Analysis included 1120 participants: 529 had undergone RRH with a median age of 55 years (IQR 48-62), compared with 39 years (33-52) without RRH. The RRH-group was significantly more likely to have had cancer, physical co-morbidities, be parous and used aspirin. Adjusted mean utilities were slightly lower in the RRH than no-RRH group (difference -0.020, 95% CI -0.045 to 0.004; p = 0.11), much lower for premenopausal women (-0.041, -0.074 to -0.008), but similar for postmenopausal women (0.003, -0.036 to 0.042). Cancer-Worry-Scale scores were lower in the RRH group (mean-difference 0.48, 95% CI -0.807 to -0.157; p = 0.0037). Interpretation was robust to sensitivity analyses.
INTERPRETATION: Health-related quality-of-life in women with Lynch Syndrome is likely to be lower following RRH in younger, pre-menopausal women. This is relevant for counselling, RRH decision making, and economic evaluations of women with Lynch Syndrome, with increased endometrial cancer risk.
FUNDING: Rosetrees Trust (CF1\100001) and Barts Charity (G-002286 and MRC0167).