Quality of Life of Primary Hepatocellular Carcinoma Patients after Radiofrequency Ablation

背景与目的以往对原发性肝癌(hepatocellular carcinoma,HCC)各种治疗疗效的评价主要从治愈率、生存率和生存时间方面进行,近年来生命质量(quality of life,QOL)研究倍受关注,能较全面地反映肝癌患者体能恢复状况和切身感受而被广泛应用于癌症、慢性病的疗效评价.目前对于经皮射频消融(radiofrequency ablation,RFA)、经动脉插管栓塞化疗(transcatheter hepatic arterial chemo-embolization,TACE)治疗意义的评价大多关注局部肿瘤灭活率及患者生存率,而对治疗后患者生命质量的研究尚不多见.本研究从患者整体角度对比评估原发性肝癌经皮射频消融治疗后患者的生命质量.方法:采用国内肝癌特异性生命质量量表(QOL-LC V2.0),对80例HCC经RFA治疗后QOL进行评定;并与同期40例经动脉插管栓塞化疗(TACE组)以及TACE+RFA(联合组)40例分别进行比较.3组患者在年龄、性别、临床分期等方面分布均衡,无明显差异.结果:RFA组的QOL总分中位数(168.6)高于TACE组(146.8),差异有显著性(P=0.025);RFA组和联合组在症状/副作用领域的得分中位数45.5、46.0,分别优于单纯TACE组38.1(P＜0.01);RFA组躯体功能领域得分呈略高于TACE组的趋势.患者的年龄、收入、治疗后Child-Pugh分级、治疗后新生/复发率、并发症等方面与患者生命质量相关.TACE组和联合组于治疗后ChildPugh分级提高的比例分别高于RFA组;TACE组新生/复发的比例明显高于RFA组.RFA组的1年、2年和3年生存率(92.8%、89.3%和76.5%)与联合治疗组(94.1%、87.4%、60.0%)比较无统计学差异,但高于TACE组(74.3%、48.2%、48.2%).结论:RFA治疗肝癌,多数患者可获得较好的疗效,严重的副作用少.TACE与RFA联合治疗与单纯TACE相比,可减少患者肝功能损伤,有利于提高原发性肝癌患者的生命质量.Previously, treatment outcome evaluation of hepatocellular carcinoma (HCC) was focused on cure rate, survival rate, and survival time. The quality of life (QOL) of cancer patients has been emphasized during the past decade, and used to evaluate treatment outcome of cancer and chronic disease. This study aimed to evaluate the QOL of HCC patients treated with radiofrequency ablation (RFA), and compare with that of patients treated with transcatheter arterial chemoembolization (TACE) or TACE in combination with RFA.A QOL questionnaire (QOL-LC V2.0) was used on 160 HCC patients, in which 80 patients underwent RFA (RFA group), 40 underwent TACE (TACE group), and 40 underwent TACE in combination with RFA (combination group). The 3 groups were comparable in distributions of age, gender, clinical stage, and so on.The median overall QOL score was higher in RFA group and combination group than in TACE group (168.6 vs. 146.8, P=0.025; 162.8 vs. 146.8, P>0.05). The median QOL score in symptom/side effect domain was significantly higher in RFA group and combination group than in TACE group (45.5 and 46.0 vs. 38.1, P<0.01). The physical score was slightly higher in RFA group and combination group than in TACE group. Spearman's correlation analysis showed that age, income, liver function, tumor recurrence, and complications were related to the QOL of HCC patients after treatment. The degree of liver function damage, complications, and tumor recurrence were significantly higher in TACE group than in RFA group (P<0.05). The 1-, 2-, and 3-year survival rates of RFA group were significantly higher than those of TACE group (92.8% vs. 74.3%, 89.3% vs. 48.2%, and 76.5% vs. 48.2%, P=0.041), but had no significant difference with those of combination group (94.1%, 87.4%, and 60.0%).RFA is an effective and micro-invasive treatment for liver cancer. Compare with TACE alone, TACE in combination with RFA may decrease liver function damage and improve QOL of HCC patients.首都医学发展科研项目; 国家"211"工程建设项目PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)07827-8332