Buccheri G F, Ferrigno D, Tamburini M, Brunelli C
2nd Pulmonary Unit, A. Carle Hospital, Cuneo, Italy.
Lung Cancer. 1995 Mar;12(1-2):45-58. doi: 10.1016/0169-5002(94)00392-z.
Only 5-10% of patients with lung cancer (LC) can be expected to be cured by radical treatments. In the remaining subjects the potential survival benefit of treatment must be weighed, taking into consideration the possible deterioration of quality of life (QL). Indeed, studies dealing with different aspects of QL are being increasingly reported in LC. In a few of them, the interesting observation was made that the patient-rated QL correlated well with the subsequent clinical outcome. In the present study we analyse 11 items of the Therapy Impact Questionnaire (a new instrument of QL), assessing both disease and therapy impact on physical condition, functional status, concomitant emotional and cognitive factors and social interactions. Questionnaires were completed by 128 consecutive LC patients, who had been seen, in the years 1990 through 1993, either for a newly diagnosed cancer (40 patients), or after a successful operation (15 patients), or during active and/or symptomatic treatment (73 patients). At the time of the QL assessment, a minimal set of demographic and clinical variables was recorded. Univariate tests of survival showed that stage of disease, difficulty at work or doing the housework, weight loss, performance status, difficulty relaxing, having been felt unsure, and tumor cell type were all associated, in decreasing order of significance, with prognosis. QL variables correlated well with each other, but poorly with clinical and demographic variables (an expected exception was the good correlation existing between working capacity/physical autonomy and the corresponding observer evaluation of performance status). This lack of correlations explains how QL variables maintained their significance in multivariate survival analyses. In the best multivariate model, the self-estimated difficulty at work or doing the housework followed the stage of disease, but preceded weight loss as a significant, independent, prognostic determinant. Further studies evaluating several other additional prognostic indicators are needed to better clarify the relative prognostic importance of quality of life.
预计只有5%至10%的肺癌（LC）患者能够通过根治性治疗治愈。对于其余患者，必须权衡治疗可能带来的生存益处，同时考虑生活质量（QL）可能的恶化情况。事实上，关于LC患者生活质量不同方面的研究报告越来越多。其中一些研究有一个有趣的发现，即患者自评的生活质量与随后的临床结果密切相关。在本研究中，我们分析了治疗影响问卷（一种新的生活质量评估工具）的11个项目，评估疾病和治疗对身体状况、功能状态、伴随的情绪和认知因素以及社会互动的影响。128例连续的LC患者完成了问卷调查，这些患者在1990年至1993年期间就诊，其中40例为新诊断的癌症患者，15例为手术后患者，73例为正在接受积极和/或有症状治疗的患者。在进行生活质量评估时，记录了一组最少的人口统计学和临床变量。生存的单因素检验表明，疾病分期、工作或做家务困难、体重减轻、体能状态、放松困难、感到不确定以及肿瘤细胞类型均与预后相关，其显著性依次降低。生活质量变量之间相关性良好，但与临床和人口统计学变量相关性较差（一个预期的例外是工作能力/身体自主性与相应的观察者对体能状态的评估之间存在良好的相关性）。这种缺乏相关性解释了生活质量变量在多因素生存分析中如何保持其显著性。在最佳的多因素模型中，自我估计的工作或做家务困难仅次于疾病分期，但在作为一个显著的、独立的预后决定因素方面，排在体重减轻之前。需要进一步研究评估其他几个额外的预后指标，以更好地阐明生活质量的相对预后重要性。
