Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago, Illinois; Department of Medicine, Division of Hematology/Oncology, Northwestern University, Chicago, Illinois.
Clin Gastroenterol Hepatol. 2013 Oct;11(10):1358-1365.e1. doi: 10.1016/j.cgh.2013.04.028. Epub 2013 May 2.
BACKGROUND & AIMS: Quality of life (QoL) is an important aspect of any palliative treatment. However, few data are available from studies comparing how embolotherapy affects QoL for patients with hepatocellular carcinoma (HCC). We performed a health-related QoL study in patients with HCC treated by transarterial chemoembolization (TACE) or (90)Y radioembolization.
We performed a prospective study of patients undergoing (90)Y radioembolization (n = 29) or TACE (n = 27) for HCC. We assessed patients before treatment and 2 and 4 weeks after treatment using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) survey. We compared differences in health-related QoL between the treatment groups using linear regression repeated-measures analysis.
At baseline, the groups had comparable baseline Child-Pugh class and performance statuses, although patients undergoing TACE had lower tumor burdens (P = .018) and less-advanced disease, based on United Network for Organ Sharing and Barcelona stage (P = .03 and P = .02, respectively), permitting injections at segmental arteries (P < .0001). There were no significant differences between groups in overall FACT-Hep health-related QoL scores (P = .055, effect size [ES], .54), owing to a limited sample size. Despite the more advanced disease of patients who received (90)Y radioembolization, they had a significantly better QoL, based on social well being (P = .019; ES, .65), functional well-being (P = .031; ES, .60), and embolotherapy-specific scores (P = .018; ES, .67). They also had a trend toward better overall QoL (P = .055; ES, .54) and higher Trial Outcome Index (P = .05; ES, .56) and FACT-Hep scores (P = .071; ES, .52).
In a prospective study, although (90)Y radioembolization was used to treat patients with more advanced disease, those who received this treatment had significant increases in several features of QoL, whereas patients who received TACE had decreases in QoL scores. However, because of the limited sample size, there was no significant difference in overall FACT-Hep health-related QoL scores. The increase was greatest in the embolotherapy-specific score. ClinicalTrials.gov, number NCT00739167.
生活质量（QoL）是任何姑息治疗的一个重要方面。然而，比较经动脉化疗栓塞（TACE）和（90）钇放射性栓塞对肝细胞癌（HCC）患者 QoL 影响的研究数据很少。我们对接受（90）钇放射性栓塞（n=29）或 TACE（n=27）治疗的 HCC 患者进行了一项与健康相关的 QoL 研究。我们使用功能性评估癌症治疗-肝胆（FACT-Hep）量表在治疗前和治疗后 2 周和 4 周对患者进行评估。我们使用线性回归重复测量分析比较了两组之间健康相关 QoL 的差异。
在基线时，两组的基线 Child-Pugh 分级和表现状态相当，尽管接受 TACE 治疗的患者肿瘤负荷较低（P=0.018），疾病进展程度较低，根据美国器官共享网络和巴塞罗那分期，TACE 治疗可进行节段性动脉注射（P<0.0001）。两组在总体 FACT-Hep 健康相关 QoL 评分方面无显著差异（P=0.055，效应量[ES]，0.54），这归因于样本量较小。尽管接受（90）钇放射性栓塞治疗的患者疾病更为严重，但他们在社会福利方面的 QoL 显著改善（P=0.019；ES，0.65）、功能福利（P=0.031；ES，0.60）和栓塞治疗特异性评分（P=0.018；ES，0.67）。他们的总体 QoL 也有改善趋势（P=0.055；ES，0.54），试验结局指数（P=0.05；ES，0.56）和 FACT-Hep 评分（P=0.071；ES，0.52）也更高。
在一项前瞻性研究中，尽管（90）钇放射性栓塞用于治疗疾病更为严重的患者，但这些患者的 QoL 多项特征显著改善，而接受 TACE 治疗的患者 QoL 评分下降。然而，由于样本量有限，两组在总体 FACT-Hep 健康相关 QoL 评分方面无显著差异。栓塞治疗特异性评分的增幅最大。ClinicalTrials.gov，编号 NCT00739167。
