Department of Traditional Chinese Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China.
World J Gastroenterol. 2012 Jun 7;18(21):2689-94. doi: 10.3748/wjg.v18.i21.2689.
To investigate and evaluate the change in health-related quality of life (HRQoL) by tumor node metastasis (TNM) staging system in patients with hepatocellular carcinoma (HCC).
A total of 140 patients diagnosed with HCC between June 2008 and April 2009 in our department were enrolled to this study. One hundred and thirty-five (96.5%) patients had liver cirrhosis secondary to hepatitis B virus (HBV) infection, 73 (54.07%) of them being HBV DNA positive; the other etiologies of liver cirrhosis were alcoholic liver disease (1.4%), hepatitis C (1.4%) or cryptogenic (0.7%). All subjects were fully aware of their diagnosis and provided informed consent. HRQoL was assessed before treatment using the functional assessment of cancer therapy-hepatobiliary (FACT-Hep) questionnaire. Descriptive statistics were used to evaluate demographics and disease-specific characteristics of the patients. One-way analysis of variance and independent samples t tests were used to compare the overall FACT-Hep scores and clinically distinct TNM stages. Scores for all FACT-Hep items were analyzed by frequency analyses. The mean scores obtained from the FACT-Hep in different Child-Pugh classes were also evaluated.
The mean FACT-Hep scores were reduced significantly from TNM Stage I to Stage II, Stage IIIA, Stage IIIB group (687 ± 39.69 vs 547 ± 42.57 vs 387 ± 51.24 vs 177 ± 71.44, P = 0.001). Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage I to Stage IIIB (P = 0.002 vs Stage I; P = 0.032 vs Stage II; P = 0.033 vs Stage IIIA). Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001 vs Stage I; P = 0.036 vs Stage II; P = 0.032 vs Stage IIIA). For the social and family well-being subscale, only Stage IIIB scores were significantly lower as compared with Stage I scores (P = 0.035). For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Stages IIΙ, IIIA and IIIB (P = 0.002 vs Stage I).
HRQoL of patients with HCC worsens gradually with progression of TNM stages. The most impaired subscales of HRQoL, as measured by FACT-Hep, were physical and emotional well-being.
通过肿瘤淋巴结转移（TNM）分期系统研究和评估肝癌（HCC）患者的健康相关生活质量（HRQoL）变化。
本研究纳入了 2008 年 6 月至 2009 年 4 月期间我科诊断为 HCC 的 140 例患者。135 例（96.5%）患者有乙型肝炎病毒（HBV）感染所致肝硬化，其中 73 例（54.07%）HBV DNA 阳性；其他肝硬化病因包括酒精性肝病（1.4%）、丙型肝炎（1.4%）或不明原因（0.7%）。所有患者均充分了解自己的诊断并签署了知情同意书。治疗前使用功能性癌症治疗-肝胆（FACT-Hep）问卷评估 HRQoL。采用描述性统计方法评估患者的人口统计学和疾病特异性特征。采用单因素方差分析和独立样本 t 检验比较总体 FACT-Hep 评分和临床不同 TNM 分期。所有 FACT-Hep 项目的评分均采用频率分析进行分析。还评估了不同 Child-Pugh 分级的 FACT-Hep 平均评分。
从 TNM Ⅰ期到Ⅱ期、ⅢA 期、ⅢB 期，FACT-Hep 评分明显降低（687±39.69 分比 547±42.57 分比 387±51.24 分比 177±71.44 分，P=0.001）。在身体和情绪健康子量表方面，评分从Ⅰ期逐渐下降至ⅢB 期（P=0.002 比Ⅰ期；P=0.032 比Ⅱ期；P=0.033 比ⅢA 期）。FACT-Hep 评分因 Child-Pugh 分级而异，尤其是在身体、功能和肝胆癌子量表方面（P=0.001 比Ⅰ期；P=0.036 比Ⅱ期；P=0.032 比ⅢA 期）。对于社会和家庭健康子量表，只有ⅢB 期的评分明显低于Ⅰ期（P=0.035）。在功能健康和肝胆癌子量表方面，Ⅱ期、ⅢA 期和ⅢB 期的评分有显著差异（P=0.002 比Ⅰ期）。
随着 TNM 分期的进展，肝癌患者的 HRQoL 逐渐恶化。FACT-Hep 测定的 HRQoL 受损最严重的子量表是身体和情绪健康。
