Health-Related Quality of Life as a Prognostic Factor in Patients After Resection of Hepatic Malignancies.
Health-Related Quality of Life as a Prognostic Factor in Patients After Resection of Hepatic Malignancies.
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健康相关的生活质量作为肝恶性肿瘤切除术后患者的预后因素。
DOI：
10.1016/j.jss.2019.07.061
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Steel,JenniferL
中科院分区：
文献类型：
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作者：
Tohme,Samer;Sanin,GloriaD;Patel,Vishaal;Bress,Kathryn;Ahmed,Naadia;Krane,Andrew;Tsung,Allan;Steel,JenniferL
背景：许多研究认为，与健康相关的生活质量（HRQoL）指标是慢性疾病（包括癌症）患者生存的预后指标；然而，只有少数小型研究评估了肿瘤切除后HRQoL的变化。本研究的目的是探讨预测HRQoL的因素，HRQoL随时间的变化，以及HRQoL在肝脏恶性肿瘤手术切除患者中的预后价值。方法对2008年1月至2011年11月和2013年11月至2015年6月期间入组的128例原发性和转移性肝脏恶性肿瘤患者进行肿瘤治疗功能评估-肝胆、流行病学研究中心-抑郁、癌症治疗功能评估-疲劳和简短疼痛量表。使用HRQoL问卷在基线、4、8和12个月获得生活质量。结果所有患者的平均年龄为61岁，42.6%为肝细胞癌，50.7%为转移性结直肠癌。HRQoL在4个月随访时从基线下降，但在8和12个月时稳定到术前值。术前HRQoL与抑郁症状（P< 0.001）、疼痛（P= 0.032）和疲劳（P< 0.001）相关。8个月时HRQoL的相关变量包括肝外复发（P= 0.002）、抑郁症状（P< 0.001）、疼痛（P< 0.001）、疲劳（P< 0.001）、肿瘤大血管（P= 0.011）和微血管侵犯（P= 0.003）。采用Cox回归并调整人口统计学和疾病特异性因素，术前HRQoL与总生存率显著相关。结论shrqol与肝恶性肿瘤手术切除患者的生存独立相关。在短期HRQoL恶化但长期总体生活质量改善和稳定的情况下，可进行重大的治愈性肝脏手术。
BackgroundNumerous studies have argued health-related quality of life (HRQoL) measures to be prognostic of survival in patients with chronic disease processes including cancer; however, only a few small studies have evaluated HRQoL changes in the setting of oncologic resections. The objectives of the present study were to investigate factors predicting HRQoL, the change in HRQoL over time, and HRQoL prognostic value in patients undergoing surgical resection of hepatic malignancies.MethodsWe administered the Functional Assessment of Cancer Therapy–Hepatobiliary, Center for Epidemiologic Studies-Depression, Functional Assessment of Cancer Therapy–Fatigue, and Brief Pain Inventory to 128 patients with primary and metastatic hepatic malignancies enrolled between January 2008 to November 2011 and November 2013 to June 2015. Quality of life was obtained at the baseline, 4, 8, and 12 mo, using HRQoL questionnaires.ResultsThe mean age of all patients included was 61 y, 42.6% had hepatocellular carcinoma, and 50.7% had metastatic colorectal carcinoma. HRQoL decreased from baseline at the 4-mo follow-up but stabilized to preoperative values at 8 and 12 mo. Depressive symptoms (P< 0.001), pain (P= 0.032), and fatigue (P< 0.001) were associated with HRQoL before surgery. Variables associated with HRQoL at 8 mo included extrahepatic recurrence (P= 0.002), depressive symptoms (P< 0.001), pain (P< 0.001), fatigue (P< 0.001), tumor macrovascular (P= 0.011), and microvascular invasion (P= 0.003). Using Cox regression and adjusting for demographics and disease-specific factors, preoperative HRQoL was significantly associated with overall survival.ConclusionsHRQoL is independently associated with survival in patients with liver malignancies undergoing surgical resection. Major curative liver surgery can be performed with short-term worsening of HRQoL but long-term improvement and stabilization in overall quality of life for patients with cancer.