临床因素对中下段直肠癌患者术后生存质量的影响

Influence of clinical characteristics on health-related quality of life after mid-low rectal cancer surgery

目的探讨临床因素对中下段直肠癌患者术后生存质量的影响。方法对2002年8月至2011年2月间收治的330例行中下段直肠癌根治性手术的患者采用欧洲癌症研究治疗组织开发的癌症患者生存质量测定核心量表3．0版（QLQ—c30）和结直肠癌患者专用生存质量测定量表1．0版（QLQ—CR38）进行术后生存质量回顾性调查，对生存质量得分按不同临床因素进行单因素及多因素回归分析。结果共收到204份有效量表。无造口患者在心理学与社会学相关领域，如情绪功能（M50=91．67，U=2668．5，P=0．026）、社会功能（M50=83．33，U=2095．5，P〈0．001）、经济困难（M50=0，U：2240．5，P〈0．001）、身体形象（M50=88．89，U=2507．0，P=0．013）4个方面的生存质量要好于有造口患者，而造口患者仅在便秘症状领域得分占优（M5。=14．29，U=2376．0，P=0．001）。按手术方式分组的分析结果与造口分组结果基本契合。有并发症患者在气促（M5。=0，U=1505．0，P〈0．001）、胃肠症状（M50=6．67，U=1766．0，P=0．034）和经济困难（M50=33．33，U=1795．5，P=0．044）等症状领域以及情绪功能（M50=83．33，U=1608．5，P=0．009）、认知功能（M50=66．67，U=1612．5，P=0．010）和身体形象（M50=66．67，U=1617．0，P=0．012）等功能领域受损较无并发症患者严重。生存质量得分随术后时间推移逐渐改善。多因素回归分析显示造口与术后时间是影响最多领域的变量，经济困难领域的生存质量与造口及并发症呈负相关，与术后时间呈正相关。结论不同的临床因素对中下段直肠癌患者术后不同领域的生存质量有影响。

Objective The present study aims to investigate health-related quality of life （HRQOL） in disease-free survivors after radical surgery for mid-low rectal cancer. Methods A retrospective cross-sectional study was performed in patients with rectal cancer who underwent primary surgery between August 2002 and Feborary 2011 by use of the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires（ n = 330）. The impact of clinical characteristics on HRQoL were assessed and compared by univariate and multivariate regression analyses. Results Two hundred and four effective responses were received. Patients with stoma were more impaired in HRQoL than those without stoma, especially in the field of social psychology, such as emotional function （M50 = 91.67, U = 2668.5, P = 0. 026 ）, social function （ M50 = 83.33, U = 2095.5, P 〈 0. 001 ）, financial difficulties （M50 = 0, U = 2240. 5, P 〈 0. 001 ） and body image （M50 = 88. 89, U = 2507.0, P = 0. 013）. Only in the constipation scale （M50 = 14. 29, U = 2376.0, P = 0. 001 ） , nonstoma patients had a better score. The analysis in different types of surgical procedure paralleled those of stoma. Patients with complication had a poorer function in some symptom scales such as dyspnoea （ M50 = 0, U = 1505.0, P 〈 0. 001 ） , gastro- intestinal symptom （M50 =6. 67, U = 1766. 0, P = 0. 034） and financial difficulties （M50 = 33.33, U = 1795.5, P = 0. 044 ）, and in some functioning scales such as emotional function （ M50 = 83.33, U =1608.5, P = 0. 009）, cognitive function （M50 = 66. 67, U = 1612. 5, P = 0. 010） and body image （M50 = 66. 67, U = 1617.0, P =0. 012）. In our study, HRQoL after rectal cancer surgery improved with time. Our multivariate analysis displayed that stoma and postoperative time were the most significant characteristics. Variables associated with worse financial status were less postoperative months, occurrence of complications and presence of stoma. Conclusions Different scales of HRQoL in patients of China after curative surgery for mid-low rectal cancer are significantly influenced by different clinical characteristics.