长期生存儿童骨肉瘤患者心理行为与生存质量的研究

Psychological behavior and the quality of life of long-term children survivors with osteosarcoma after neoadjuvant chemotherapy and limb salvage

目的分析新辅助化疗及保肢治疗对长期生存儿童骨肉瘤患者心理行为及生存质量的影响。方法回顾分析1999年12月～2005年11月应用新辅助化疗及保肢治疗的25例儿童骨肉瘤患者。男11例,女14例,平均年龄12岁(5～16岁)。股骨远端17例,胫骨近端7例,肱骨近端1例。Enneking外科分期均为IIB期。对所有患者进行随访,计算5年无瘤生存率,对长期生存的13例患者参照MSTS93评分标准进行患肢功能评价,采用90项自觉症状自评量表(SCL-90)和中文版医学结局研究简明调查表(SF-36)进行心理行为与生存质量评估。结果25例患者术后中位随访时间21个月(12～120个月),5年无瘤生存率为44.0%。13例长期生存的患者MSTS93评分平均21.6分(14～29分),优良率为69.2%;SCL-90量表各因子分均值在1.46～2.31之间,其中人际关系、躯体化、焦虑、恐怖得分均高于常模(P<0.05);SF-36量表显示患者活力、总体健康、生理功能得分较低,其生存质量各维度得分由大到小依次为情感职能、社会功能、精神健康、生理职能、躯体疼痛、生理功能、总体健康、活力。结论骨肉瘤新辅助化疗及保肢治疗可使患儿获得较高的长期生存率,但对患者心理行为和生存质量产生了一定程度的影响,提示需要加强骨肉瘤患儿的心理支持,提高患儿生存质量。

Objective To investigate the effect of neoadjuvant chemotherapy and limb salvage on the psychological behavior and the quality of life （QOL） of long-term children survivors with osteosarcoma. Methods 25 children, including 11 boys and 14 girls, aged from 5 to 16, with the average of 12, who underwent limb salvage with effective preoperative chemotherapy between 1999 and 2005 were analyzed retrospectively. The distal femur was involved in 17 cases, the proximal tibia in 7 cases, and the upper end of humerus in I case. All patients were followed up, and the 5-years event-free survival rate was calculated. 13 long-terra survivors＇ limb functions were evaluated according to MSTS93. Psychological behavior was evaluated with Symptom Checklist 90（SCL-90）, and the QOL was evaluated with Short Form 36. Results At the median follow-up of 21 months, the 5-year event-free survival rate was. The excellent-good rate of the affected limb function was 69.2%. The average score of individual factor of SCL-90 was 1.46-2.31. The main serious symptom factors--interpersonal sensitivity, somatization, anxiety, and fear scored higher than normal. SF-36 scale showed that patients＇ vitality, general health, and physical function scored low. The QOL scores in descending order were emotional function, social function, mental health, physical function, body pain, physical function, general health, and vigor. Conclusions Higher long-term survival rate can be achieved in children through neoadjuvant chemotherapy and limb salvage, but the psychological behavior and the QOL were affected, especially in interpersonal relationships, anxiety, vitality, and general health. So we should pay attention to mental support, and improve their QOL.