食管癌患者生存质量对其预后影响的前瞻性随访研究

摘要

目的：探讨基线生存质量和治疗后生存质量变化对食管癌患者生存期的影响。方法本研究为前瞻性随访研究。选取2009年5月⁃2010年5月南京军区福州总医院95临床部确诊的食管癌患者，分为手术组和放化疗组。两组共有98例患者经过6个月高强度食管癌治疗后仍然存活。这个存活样本通过欧洲肿瘤研究和治疗组织（ EORTC）的量表（ EORTC QLQ⁃C30和EORTC QLQ⁃OES18）来测量基线生存质量和治疗后6个月生存质量的变化。随后按计划继续随访患者的生存质量直到患者死亡、失访和研究结束（2014年5月）。用COX 风险系数模型分析生存质量数据和生存时间的关系。结果 COX风险系数模型发现，在控制其他混杂因素之后，基线生存质量中的躯体功能评分可显著预测食管癌患者的生存时间（P＝0．002），基线的躯体功能评分每提高10分，患者的死亡风险降低11％（95％可信区间5％～17％）。如果在模型中考虑存活6个月后的生存质量，情绪功能评分是显著性变量。它每提高10分可降低35％的死亡风险（95％可信区间20％～47％， P＜0．01）。结论基线和治疗后生存质量是重要的预测食管癌患者生存时间的数据。临床上应提倡使用患者师存质量数据来提高医生的医疗决策。%Objective o investigate the predictive value of baseline QoL scores and QoL improvement after treatment in pa⁃tients with esophageal cancer. Methods We conducted a prospective study in First Affiliated Hospital of Fuzhou Military General Hos⁃pital from 2009 to 2014 with a sample of 98 patients who survived the initial 6⁃month esophageal cancer treatment. Baseline QoL were measured with the European Organisation for Research and Treatment of Cancer ( EORTC) core questionnaire ( EORTC QLQ⁃C30) and the oesophageal module ( EORTC QLQ⁃OES18) . Then patients were divided into two groups. Surgical group consisted of patients who had their stomach removed by operations while medical group comprised patients receiving chemo therapy only. Both groups measured QoL at scheduled time throughout the study period or patients died. Survival analysis and Cox�s models were used to quantify the impact of baseline QoL variables and QoL improvement on patients� survival. Results After adjusting for confounders, Cox regression found that physical function of QoL before treatment was significantly associated with survival time ( P=0.002) . Every 10 points increasing in physical function was associated with 11% ( 95% confidence intervals 5%–17%) reduction in the likelihood of death. When consider⁃ing QoL at 6⁃month survival in the model, emotional function become a significant variable and was related to 35% reduction in likeli⁃hood of death (95% confidence intervals 20%-47%, P<0.01). Conclusion QoL scores at baseline and after initial treatment are im⁃portant to predict the survival of patients with esophageal cancer. This type of data should be used by clinicians in their management of patients with esophageal cancer.