鼻咽癌适形调强放疗后长期幸存者认知功能和生活质量横断面调查

Cognitive Function and Quality of Life for Long-term Survivors of Nasopharyngeal Cancer Treated by Intensity-modulated Radiation Therapy: A Cross-sectional Study

目的:探讨鼻咽癌适形调强放疗(IMRT)后长期幸存者的认知功能、生活质量、情绪及其相互关系。方法:采用横断面调查分析在本院接受IMRT根治性治疗的54例鼻咽癌幸存者。使用蒙特利尔认知评估量表(MoCA)评估认知功能,情绪评估采用焦虑、抑郁自评量表,生活质量评估采用鼻咽癌专用癌症治疗功能评价系统(FACT-NP)。结果:放疗后中位存活时间14.5月(7月～6.5年),中位年龄44.5岁(18～71岁),34例(63.0%)存在放疗后轻度认知功能障碍。教育水平越高,认知功能评分越高。双侧颞叶D_(max)≥65Gy或V_(60)≥1.10cm^3是认知功能损伤的危险因素。MoCA量表评分与年龄、性别、吸烟饮酒史、合并症、情绪评分、AJCC分期、T分期、化疗方式、放疗后时间、生活质量评分均无相关性。1例患者(1.9%)有焦虑症状,4例患者(7.4%)有抑郁症状。抑郁评分越高,生活质量评分越低。结论:鼻咽癌IMRT后长期幸存者轻度认知功能障碍较为常见,与教育水平和颞叶受照剂量相关。焦虑抑郁状态虽不常见,但却影响生活质量。

Objective:To study the cognitive function,quality of life (QOL)and moods of long-term survivors of nasopharyngeal cancer (NPC)patients treated by intensity-modulated radiotherapy (IMRT).Methods:A cross-sectional study evaluating 54NPC survivors with IMRT in our hospital was conducted.We used Montreal Cognitive Assessment (MoCA)to test the cognitive function,used FACT-NP to test QOL,and used the Hospital Anxiety and Depression Scale (HADS)to test mood.Results:Median survival time after IMRT was 14.5 months (7 months ~6.5 years),and the median age was 44.5 years (18-71 years).In total,34 patients (63.0%)were defined as mild cognitive impairment.Higher MoCA scores were associated with higher education level.Bilateral temporal lobe with Dmax ≥65Gy or V60 ≥1.10cms was a risk factor for cognitive impairment.Age,gender,smoking and alcohol history,complicated diseases,mood scores,TNM stage,chemotherapy,time after IMRT,QOL did not correlate with MoCA scores.One patient (1.9%)suffered from anxiety and 4 (7.4%)suffered from depression.The higher the depression score was,the lower the QOL score was.Conclusion:Mild cognitive impairment after IMRT is common in NPC survivors. Education level and radiation dose of temporal lobe were asso-ciated with cognitive function.Anxiety and depression are not common but will affect the QQL.