Survival and quality of life in gastrointestinal tumors: Two different end points?
Survival and quality of life in gastrointestinal tumors: Two different end points?
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DOI：
10.1093/annonc/12.suppl_3.s31
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发表时间：
2001-01-01
影响因子：
50.5
通讯作者：
Salvagni, S
中科院分区：
文献类型：
--
作者：
Cascinu, S;Labianca, R;Salvagni, S
背景：在胃肠道肿瘤中，传统的医疗终点主要以生存情况来体现。然而，在过去几年中，人们对生活质量的作用有了越来越多的认识。
设计：本文旨在探讨结直肠癌、胃癌、胰腺癌和肝癌中这两个重要的终点及其相互关系。
结果：在胃肠道肿瘤中，与最佳支持治疗相比，化疗使生存期延长了一倍。在结直肠癌和胃癌有症状的患者中，约一半患者预计会出现以癌症相关症状减轻为表现的主观缓解。在胰腺癌中，临床获益方面的积极结果有助于确定化疗的作用。尽管临床获益并非衡量生活质量的有效工具，但它可以是定义新的、更简单的工具以评估这一终点的第一步。肝细胞癌（HCC）患者中常常伴有严重的并发疾病——肝硬化，这通常阻碍了在这些肿瘤中使用化疗，这些肿瘤通常采用局部治疗。不幸的是，它们对这些患者的生存和生活质量的影响从未得到充分评估。
结论：在许多胃肠道癌症中，化疗可以提高生存率并改善生活质量。评估新药和/或联合用药的进一步研究应关注这些方面及其相互关系。特别是，必须通过精心设计的前瞻性试验来研究肝细胞癌治疗对生存和生活质量的影响。在评估一种特定抗癌治疗的价值时，重要的是不仅要考虑它对生存的影响，还要考虑对生活质量的影响。对于预期寿命可能较短的癌症患者来说，尤其如此。
Background: In gastrointestinal tumors, the traditional end point of medical treatment was represented mainly by survival. In the last few years, however, there has been an increasing awareness about the role of quality of life.Design: This paper seeks to discuss these two important end points and their relationship in colorectal, gastric, pancreatic and liver cancers.Results: Chemotherapy has doubled survival in comparison with best supportive care in gastrointestinal tumors. A subjective response, represented by a decrease in cancer-related symptoms is expected in about half of the symptomatic patients in colorectal and gastric cancer. In pancreatic cancer, the positive results in terms of clinical benefit helped define the role of chemotherapy. Although clinical benefit does not represent a validated tool to measure quality of life, it can be a first step in the definition of new, simpler tools to assess this end point. The frequent presence of a serious concomitant disease, liver cirrhosis, in patients with hepatocellular carcinoma (HCC) usually prevents the use of chemotherapy in these tumors, which are often treated with locoregional treatments. Unfortunately, their impact on the survival and quality of life of these patients has never been adequately assessed.Conclusions: In many gastrointestinal cancers, chemotherapy can produce a survival gain and an improvement in the quality of life. Further studies assessing new drugs and/or combinations should focus on these aspects and their relationships. In particular, the impact of treatments of HCC on both survival and quality of life must be investigated by well-designed prospective trials. When assessing the value of a particular anticancer treatment, it is important to consider the impact it may have not only on survival but also on quality of life. This is particularly so for cancer patients, whose life expectancy may be short.