Department of Diagnostic and Interventional Radiology, Hanover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
Beaumont Hospital, Beaumont Rd, Dublin 9, Ireland.
J Cancer Res Clin Oncol. 2018 Oct;144(10):1991-1999. doi: 10.1007/s00432-018-2704-7. Epub 2018 Jul 14.
With a limited overall survival (OS) of 20 months in patients diagnosed with intermediate stage hepatocellular carcinoma (HCC), the preservation of quality of life (QoL) during transarterial chemoembolization (TACE) procedures remains a primary goal. The aim of our study was to evaluate the change in QoL amongst patients undergoing repetitive TACE and to identify specific risk factors that may predict change in QoL.
QoL was assessed in 82 patients undergoing at least two TACE, before and 14 days after TACE, using validated EORTC QLQ-C30 and EORTC HCC18 questionnaires. Tumour response was assessed using established response criteria. Laboratory and clinical parameters were analysed.
Functional scores decreased due to first TACE treatment (p < 0.01), conversely symptom scores increased significantly (p < 0.01). During repetitive TACE no statistically significant changes were observed. Higher Global Health- and Physical Functioning scores at baseline were identified as independent prognostic factors for greater decrease in QoL. Tumour response did not alter QoL at all. Furthermore higher symptom scales including pain (p = 0.00), nausea and vomiting (p = 0.00) and fever (p < 0.01 for repetitive TACE) at baseline were predictive of a significantly lesser increase of symptom severity, and a greater reduction in pain during a course of TACE. Higher C-reactive protein (CRP) at baseline and female gender were associated with a greater decrease of functional scales and increase of symptom scales.
QoL amongst patients receiving repetitive TACE showed neither significant nor clinically relevant changes over time. Pre-treatment assessment of QoL-scores, clinical and laboratory parameters can improve patient selection for TACE whilst optimizing QoL.
在诊断为中期肝细胞癌（HCC）的患者中，总生存期（OS）仅为 20 个月，因此，在经动脉化疗栓塞（TACE）过程中保留生活质量（QoL）仍然是主要目标。我们的研究目的是评估接受重复 TACE 的患者 QoL 的变化，并确定可能预测 QoL 变化的特定危险因素。
使用经过验证的 EORTC QLQ-C30 和 EORTC HCC18 问卷，在至少接受两次 TACE 治疗之前和 TACE 治疗后 14 天，对 82 例接受 TACE 治疗的患者进行 QoL 评估。使用既定的反应标准评估肿瘤反应。分析实验室和临床参数。
由于首次 TACE 治疗，功能评分降低（p<0.01），相反，症状评分显著增加（p<0.01）。在重复 TACE 期间，未观察到统计学上的显著变化。基线时较高的总体健康状况和身体功能评分被确定为 QoL 更大下降的独立预后因素。肿瘤反应根本不会改变 QoL。此外，较高的症状量表，包括疼痛（p=0.00）、恶心和呕吐（p=0.00）和发热（p<0.01），预测了症状严重程度显著降低，以及 TACE 过程中疼痛明显减轻。基线时较高的 C 反应蛋白（CRP）和女性性别与功能量表的下降幅度更大和症状量表的增加幅度更大相关。
接受重复 TACE 的患者的 QoL 随时间的推移既没有显著变化，也没有临床相关变化。在 TACE 之前对 QoL 评分、临床和实验室参数进行评估，可以改善患者对 TACE 的选择，同时优化 QoL。
