Different nuances between patient- and surgeon-reported outcomes in intramedullary ependymoma surgery.

Abstract

Objective: With regard to intramedullary ependymoma surgery, most studies have presented surgeon-reported outcomes (SROs) such as McCormick grade, but few have evaluated patient-reported outcomes (PROs) using quality-of-life questionnaires. This retrospective study of patients who underwent surgery for intramedullary ependymoma was performed to analyze PROs and compare them with SROs.

Methods: PROs were assessed using EQ-5D-5L (5-level version of the 5-dimension EuroQoL questionnaire) data collected preoperatively and at least 6 months postoperatively from patients with histologically confirmed ependymoma treated with surgery between September 2016 and December 2023. Pre- and postoperative EQ-5D-5L indices, along with changes across the 5 dimensions of the instrument, were analyzed. A favorable PRO required a postoperative EQ-5D-5L index ≥ the preoperative EQ-5D-5L index and a postoperative EQ-5D-5L index ≥ the linear regression line between pre- and postoperative EQ-5D-5L indices. A favorable SRO was defined as modified McCormick Scale grade I and was compared to a favorable PRO. Prognostic factors for attaining favorable outcomes on both measures were also evaluated.

Results: Among 76 patients included in this analysis, the mean follow-up was 34.7 ± 22.4 months. Among the dimensions of the EQ-5D-5L, mobility worsened postoperatively and pain/discomfort remained the dimension with a severe problem. A favorable PRO was attained by 33% (n = 25) of the patients and a favorable SRO by 38% (n = 29), with only 52% (n = 15) overlap between the two. The pain/discomfort dimension of the EQ-5D-5L was the key factor contributing to the discrepancy between PRO and SRO. Younger age was identified as a significant prognostic factor for attaining favorable outcomes on both measures.

Conclusions: There was a discrepancy between PRO and SRO primarily due to the inadequate reflection of patient pain/discomfort on the SRO. This discrepancy highlights the importance of considering both perspectives in patient counseling and management.