Glimelius B, Hoffman K, Olafsdottir M, Påhlman L, Sjödén P O, Wennberg A
Department of Oncology, Akademiska sjukhuset, Uppsala, Sweden.
Eur J Cancer Clin Oncol. 1989 May;25(5):829-35. doi: 10.1016/0277-5379(89)90128-4.
Physician- and patient-rated 'quality of life' was studied in patients receiving chemotherapy for advanced symptomatic colorectal cancer. The patients participated in a Nordic multicentre randomized study comparing single-drug 5-fluorouracil (5-FU) with a combination of sequential methotrexate-5-FU with leucovorin rescue (MFL). Forty-four patients (all patients included at one of the hospitals) entered this associated 'quality of life' study, 22 in each group. In the MFL group, five patients had a partial remission (PR) and seven prolonged stationary disease (SD), whereas in the 5-FU group, only one patient had a PR and two SD. Median survival was longer in the MFL group (9 months) than in the 5-FU group (4 months). According to the physicians' judgement, 12 (55%) of the patients randomized to MFL experienced improved 'quality of life' compared to five (23%) in the 5-FU group. Patients' ratings gave the same figure (55%) in the MFL group, whereas only two (9%) patients in the 5-FU group considered themselves improved. The correlations between physicians' and patients' ratings were good. Adverse effects of treatment were minor and influenced ratings negatively only in one patient (5-FU group). Items that reflected changes in everyday activities discriminated better than other items in the 'quality of life' assessment. Since 'quality of life' measures were better in the MFL group in this associated study, and since objective and subjective responses, changes in Karnofsky performance status (KPS) and in survival also were better in the MFL group, not only in this study but also in the Nordic trial (249 patients randomized), we conclude that MFL is superior to 5-FU as a palliative treatment.
对晚期有症状的结直肠癌化疗患者的医生和患者评定的“生活质量”进行了研究。患者参与了一项北欧多中心随机研究，该研究比较了单药5-氟尿嘧啶（5-FU）与甲氨蝶呤-5-FU序贯联合亚叶酸解救（MFL）。44例患者（所有患者均来自其中一家医院）进入了这项相关的“生活质量”研究，每组22例。在MFL组中，5例患者部分缓解（PR），7例疾病稳定期延长（SD）；而在5-FU组中，只有1例患者PR，2例SD。MFL组的中位生存期（9个月）长于5-FU组（4个月）。根据医生的判断，随机分配至MFL组的患者中有12例（55%）“生活质量”得到改善，而5-FU组为5例（23%）。患者自评结果显示MFL组同样为55%，而5-FU组只有2例（9%）患者认为自己有所改善。医生评定与患者评定之间的相关性良好。治疗的不良反应轻微，仅1例患者（5-FU组）的评定受到负面影响。在“生活质量”评估中，反映日常活动变化的项目比其他项目的区分度更好。由于在这项相关研究中MFL组的“生活质量”指标更好，并且客观和主观反应、卡诺夫斯基功能状态（KPS）变化及生存期在MFL组也更好，不仅在本研究中如此，在北欧试验（249例随机分组患者）中也是如此，我们得出结论，作为姑息治疗，MFL优于5-FU。
