Objectives

To analyze gender-based differences in distress symptoms in patients with non-metastatic renal cell carcinoma (RCC) at different stages of disease.

Methods

The Edmonton Symptom Assessment System—revised (ESAS-r) questionnaire includes a physical (PHSDSS) and a psychological distress sub-score (PDSS). The ESAS-r was used to measure psychological and physical distress symptoms in localized RCC patients in a major cancer referral center between 2014 and 2017 at four predefined time points: (a) diagnosis, (b) biopsy, (c) surgery, and (d) last follow-up. Results were gender stratified, and multivariable linear regression models were used to determine associations with increased sub-scores.

Results

Overall, 495 patients were included with 37.2% females. No significant gender differences were seen in mean age, relevant clinical parameters, and treatment. PDSS was significantly higher in females after diagnosis (8.5 vs. 5.1, p = 0.018), biopsy (8.9 vs. 4.1, p = 0.003), and surgery (6.5 vs. 4.4, p = 0.007), while being similar at the last follow-up. The multivariable model demonstrated a statistically significant association of female gender with higher PDSS after diagnosis (B = 3.755, 95% CI 0.761–6.750), biopsy (B = 6.076, 95% CI 2.701–9.451), and surgery (B = 1.974, 95% CI 0.406–3.542). PHSDSS was significantly higher in females after biopsy (10.0 vs. 5.7, p = 0.028) and surgery (8.6 vs. 6.1, p = 0.022). In the multivariable model, female gender conferred a higher PHSDSS only after surgery (B = 2.384, 95% CI 0.208–4.560).

Conclusions

Gender-associated psychological distress differences exist in non-metastatic RCC patients throughout treatment, while dissipating at last follow-up. Emphasis should be placed on screening for distress symptoms and providing psychological support continuously, particularly for female patients.

中文翻译：

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诊断为非转移性肾细胞癌的患者基于性别的心理和生理困扰差异。

目标

分析非转移性肾细胞癌（RCC）患者在不同疾病阶段的困扰症状中基于性别的差异。

方法

修订版埃德蒙顿症状评估系统（ESAS-r）问卷包括身体（PHSDSS）和心理困扰子评分（PDSS）。ESAS-r用于在2014年至2017年之间的四个预定时间点测量主要癌症转诊中心中局部RCC患者的心理和身体不适症状：（a）诊断，（b）活检，（c）手术和（ d）最后的随访。结果按性别分层，并使用多变量线性回归模型确定与增加的子得分的关联。

结果

总体上，包括495名患者，其中37.2％为女性。平均年龄，相关临床参数和治疗均未见明显的性别差异。诊断后的女性PDSS显着更高（8.5 vs. 5.1，p  = 0.018），活检（8.9 vs. 4.1，p  = 0.003）和手术（6.5 vs. 4.4，p  = 0.007），但最后一次相似跟进。多变量模型显示，诊断后（B  = 3.755，95％CI 0.761–6.750），活检（B  = 6.076、95％CI 2.701–9.451）和手术（B  = 1.974， 95％CI 0.406–3.542）。活检后女性的PHSDSS显着增高（10.0 vs. 5.7，p = 0.028）和手术（8.6 vs. 6.1，p  = 0.022）。在多变量模型中，女性仅在手术后才获得更高的PHSDSS（B  = 2.384，95％CI 0.208–4.560）。

结论

在整个治疗过程中，非转移性RCC患者中存在与性别相关的心理困扰差异，而在最后一次随访中消失。应着重于筛查遇险症状并持续提供心理支持，特别是对于女性患者。