外科手术对乳腺癌患者术后生活质量的影响及中介因素的前瞻性研究

A prospective study on the impact of surgical treatment on postoperative quality of life and mediating factors in breast cancer patients

摘要:

背景与目的 外科手术是乳腺癌治疗的核心手段，但手术带来的身体损伤和心理负担影响患者的生活质量（QoL）。本研究基于前瞻性队列数据，探讨乳腺癌患者术后QoL的变化及其中介效应因素，为围手术期康复管理提供依据。方法 纳入2024年6月—2025年1月在四川省遂宁市中心医院接受局部手术治疗的女性乳腺癌患者，在术前、术后使用Constant-Murley肩关节评分、欧洲癌症治疗研究组织QLQ-C30与QLQ-BR23量表对患者肩关节功能和QoL进行评价。采用配对t检验分析手术前后评分差异，并运用中介效应模型分析手术对QoL的间接影响路径。此外，进一步进行亚组分析比较不同手术方式对QoL变化的影响。结果 共纳入148例患者，中位年龄54（46~60）岁，术后肩关节功能和QoL评分明显下降（均P<0.001）。QLQ-C30显示术后躯体、角色等功能维度下降，症状维度加重；QLQ-BR23中乳房与上肢症状评分明显升高（均P<0.001）。亚组分析发现，接受腋窝淋巴结清扫患者术后肩关节功能下降和QoL恶化程度明显高于行前哨淋巴结活检患者（均P<0.05）；乳房切除术与保乳术患者QoL下降程度相近，但疼痛和乳房症状更为突出。中介效应分析表明，肩关节功能、乳房症状和躯体功能在手术影响QoL中发挥中介作用，良好情绪则具有保护性效应。结论 外科手术显著影响乳腺癌患者术后QoL，局部功能损伤和症状加重是主要中介因素。不同手术方式对QoL影响存在差异。术后加强肩部康复、症状管理和心理疏导，有助于提升患者QoL。

Abstract:

Background and Aims Surgical treatment is a cornerstone of breast cancer management; however, the physical trauma and psychological burden associated with surgery may adversely affect patients' quality of life (QoL). Based on data from a prospective cohort, this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL, thereby providing evidence for perioperative rehabilitation strategies.Methods Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled. The Constant-Murley Shoulder Score, EORTC QLQ-C30, and QLQ-BR23 questionnaires were used pre- and postoperatively to assess shoulder joint function, and QoL. Paired t-tests were used to analyze changes in scores before and after surgery. A mediation model was applied to explore the indirect pathways through which surgery impacts QoL. Additionally, subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results A total of 148 patients were included, with median age of 54 (46-60) years old Postoperative psychological health significantly improved, while shoulder function and overall QoL scores markedly declined (all P<0.001). According to QLQ-C30, functional domains such as physical and role functioning worsened, while symptom burden increased. The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively (both P<0.001). Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy (both P<0.05). QoL deterioration was comparable between mastectomy and breast-conserving surgery, although the former was associated with more prominent pain and breast symptoms. Mediation analysis indicated that shoulder function, breast symptoms, and physical functioning served as mediators in the impact of surgery on QoL, while better psychological health exerted a protective effect.Conclusion Surgical treatment significantly affects postoperative QoL in breast cancer patients, with local functional impairment and symptom exacerbation serving as key mediators. Different surgical approaches have varying impacts on QoL. Enhancing postoperative shoulder rehabilitation, symptom management, and psychological support may improve patients' QoL.