Fang Fu-Min, Liu Yi-Tien, Tang Yeh, Wang Chong-Jong, Ko Sheung-Fat
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao Sung Hsian, Kaohsiung Hsien, Taiwan, China.
Cancer. 2004 Jan 15;100(2):425-32. doi: 10.1002/cncr.20010.
Accumulating reports suggest that quality of life (QoL) may predict survival in patients with malignant disease. In the current study, the authors investigated if baseline QoL and changes in QoL during treatment were prognostic for patients with advanced head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy.
The authors studied 102 consecutive new patients with HNSCC treated with primary radiotherapy. The Taiwan Chinese versions of the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and Head and Neck Quality of Life Questionnaire (EORTC QLQ-H&N35) were completed before and during radiotherapy. The Cox proportional hazards models were used to analyze the impact of clinical and QoL variables on survival.
Clinical variables that were significant survival predictors included American Joint Committee on Cancer (AJCC) stage, N status, and Karnofsky performance status (KPS) after multivariate analysis. After introducing the QoL variables, baseline fatigue scale and N status emerged as the most significant survival predictors, whereas KPS lost its significance. Changes in the QoL scales during radiotherapy were not significantly correlated with survival. An increase in the baseline fatigue score of 10 points corresponded to a 17% reduction in the likelihood of survival (95% confidence interval: 8-27%). Significant correlations between baseline fatigue scale and KPS, comorbidity, hemoglobin level, AJCC stage, T status, and most QoL scales also were observed.
The data support the correlation of patient reported QoL scales with survival. Pretreatment fatigue level was a significant survival predictor for patients with advanced HNSCC treated with radiotherapy.
越来越多的报告表明，生活质量（QoL）可能预测恶性疾病患者的生存情况。在本研究中，作者调查了基线生活质量以及治疗期间生活质量的变化对于接受放疗的晚期头颈部鳞状细胞癌（HNSCC）患者是否具有预后价值。
作者研究了102例连续接受初次放疗的新发HNSCC患者。在放疗前及放疗期间完成了欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）和头颈部生活质量问卷（EORTC QLQ-H&N35）的台湾中文版。采用Cox比例风险模型分析临床和生活质量变量对生存的影响。
多因素分析后，显著的生存预测临床变量包括美国癌症联合委员会（AJCC）分期、N分期和卡诺夫斯基体能状态（KPS）。引入生活质量变量后，基线疲劳量表和N分期成为最显著的生存预测因素，而KPS失去了其显著性。放疗期间生活质量量表的变化与生存无显著相关性。基线疲劳评分增加10分对应生存可能性降低17%（95%置信区间：8-27%）。还观察到基线疲劳量表与KPS、合并症、血红蛋白水平、AJCC分期、T分期以及大多数生活质量量表之间存在显著相关性。
数据支持患者报告的生活质量量表与生存之间的相关性。治疗前疲劳水平是接受放疗的晚期HNSCC患者的一个显著生存预测因素。
