不同TNM分期乳腺癌患者规范化治疗后生存期生命质量评价

Evaluation of the quality of life in patients with breast cancer at different TNM stages afterstandardized treatment

目的评价规范化治疗后不同TNM分期乳腺癌患者的生命质量，以及欧洲五维健康量表（EQ-5D）在中国乳腺癌患者生命质量测评中的应用价值。方法采用国内乳腺癌患者生命质量测定调查量表（QLICP-BR）和EQ-5D中文版，分别测量于6个月前完成规范化治疗（内分泌治疗除外）的乳腺癌患者生命质量。采用X2检验、单因素方差分析、协方差分析等统计学方法分析影响乳腺癌患者生命质量的因素。以QLICP-BR量表中共性模块（QLICP-GM）的得分和QLICP-BR总分为标准，采用Pearson相关分析评价EQ-5D量表的应用价值。结果2010年3—9月共收集符合纳入排除标准的女性乳腺癌患者178例，其中0期和I期47例，Ⅱ期81例，Ⅲ期和Ⅳ期50例。控制年龄、文化程度、职业、出生地（城市和农村）、家庭月收入、医保支付情况后，0期和I期患者调整QLICP-BR总分为（72．55±3．10）分，Ⅱ期患者为（64．09±2．69）分，Ⅲ期和Ⅳ期患者为（58．21±3．00）分，不同TNM分期患者调整QLICP-BR总分差异有统计学意义（P：0．002）。0期和I期患者的QLICP-BR总分和社会功能调整生命质量得分均高于Ⅱ期患者（均P〈0．05）；O期和I期患者的QLICP-BR总分、特异模块、心理功能、社会功能和躯体功能调整生命质量得分均高于Ⅲ期和Ⅳ期患者（均P〈0．05）。不同TNM分期乳腺癌患者EQ-5D效用得分与相应的QLICP-GM得分和QLICP-BR总分均呈正相关（均P〈0．05）。结论TNM分期早的患者生命质量较好，早诊早治可以提高乳腺癌患者的生命质量。EQ-SD量表对不同TNM分期患者生命质量的测定有良好的区分度，可用于中国女性乳腺癌患者生命质量的评价。

Objective To evaluate the quality of life （QOL） in patients with breast cancer at different TNM stages and to estimate the value of EuroQol Five Dimension Indicator （EQ-SD） in measuring QOL among Chinese breast cancer patients, Methods A survey with Quality of Life Instruments for Cancer Patients-Breast Cancer （QLICP-BR） and EQ-SD was undertaken in breast cancer patients who had completed their standardized treatment （except for the endocrine treatment） six months ago. Chi-square test, one-way ANOVA, and covarianee analysis were used to evaluate the possible factors influencing the QOL of breast cancer patients. Simultaneously, with the results of Quality of Life Instruments for Cancer Patients- General Module （QLICP-GM, which is included in QLICP-BR. ） and the total scores of QLICP-BR as standard, we conducted Pearson correlation analysis to evaluate the value of EQ-SD. Results A total of 178 female breast cancer survivors were collected from March 2010 to September 2010. There were 47 cases （26.4%） at stage 0 and I , 81 cases （45.5%） at stage Ⅱ , and 50 cases （28.1%） at stage Ⅲ and Ⅳ. The total standardized score of QLICP-BR was 72.55 ± 3.10 in patients at stage 0 and I , 64.09 ± 2.69 in patients at stage Ⅱ and 58.21 ± 3.00 in patients at stageⅢ and Ⅳ. The total standardized score of QLICP- BR and social domain of patients at stage 0 and I were higher than patients at stage Ⅱ （ all P 〈 0.05 ）. The total standardized score of QLICP-BR, specific domain of breast cancer, psychological, social and physical domains of patients at stage 0 and Ⅰ were higher than patients at stage Ⅲ and Ⅳ （ all P 〈 O. 05 ）.Covariance analysis showed that QOL standardized scores were significantly different across TNM stages when age, degree of education, birth place （metropolis or rural） , occupation, domestic income, and medical insurance were controlled （P = 0.002）. Correlation analysis indicated that EQ-5 D has a positive correlation with QLICP-GM and QLICP-BR （ all P 〈 0.05 ）. Conclusions QOL of patients with early stage breast cancer is better than those at late stage. Early diagnosis and treatment can improve QOL of breast cancer patients. Chinese version of EQ-SD can well detect the differences of QOL among patients with different TNM stages, which can be used for evaluating QOL in Chinese female breast cancer patients.