采用肿瘤淋巴结转移分期系统评估肝癌患者的健康相关生活质量。
Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma.
机构信息
Department of Traditional Chinese Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China.
出版信息
World J Gastroenterol. 2012 Jun 7;18(21):2689-94. doi: 10.3748/wjg.v18.i21.2689.
AIM
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).
METHODS
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.
RESULTS
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).
CONCLUSION
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.
目的
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。
方法
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。
结果
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）。
结论
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。
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