老年中晚期原发性肝癌患者生活质量及其对生存期的影响

Life quality and its impact on survival in the elderly patients with middle and advanced liver cancer

目的:观察老年中晚期原发性肝癌患者的生活质量状况及其对生存期的影响。方法:回顾性分析2014年01月至2016年12月我院收治的115例老年原发性肝癌患者,调查他们的生活质量指数(LQI),比较不同LQI水平原发性肝癌患者的生存情况,并分析影响预后的危险因素。结果:本组患者生活质量的总分是(118.72±34.26)分,LQI是0.59±0.13。参照患者1年生存状态,LQI的最佳临界值为0.63,曲线下面积为0.696。高LQI组的中位生存时间为16.5个月,显著高于低LQI组的12.4个月(P=0.037)。与低水平LQI组比较,高水平LQI组的年龄、谷丙转氨酶(ALT)、谷草转氨酶(AST)、凝血酶原时间(PT)、总胆红素(TBIL)和甲胎蛋白(AFP)水平以及门静脉癌栓发生率、保守治疗率更小或更低,白蛋白(ALB)水平和BCLC分期更高,差异均有统计学意义(P<0.05)。单因素分析结果显示,老年中晚期原发性肝癌的预后与ALB、AFP、Child-Pugh分级、门静脉癌栓、肝外转移、BCLC分期、药物保守治疗和LQI相关(P<0.05)。多因素分析结果显示,AFP≥400 ng/ml、BCLC C期和药物保守治疗是预后的独立危险因素(P<0.05),而非门静脉癌栓、非肝外转移、LQI≥0.63是其独立保护因素(P<0.05)。结论:老年中晚期原发性肝癌患者生活质量较低,生活质量越低,预后越差。

Objective:To investigate the life quality and its impact on survival in the elderly patients with middle and advanced liver cancer.Methods:The clinical data of 115 elderly patients with middle and advanced liver cancer from Jan.2014 to Dec.2016 were reviewed.Their life quality index(LQI)was investigated.The survival of patients with different LQI levels was compared,and the risk factors for prognosis were analyzed.Results:The total score of life quality in the group was(118.72±34.26)scores,and LQI was 0.59±0.13.Based on the 1 year survival status,the best critical value of LQI was 0.63,and the area under the curve was 0.696.The median survival time in the high LQI group was significantly higher than that in the low LQI group(16.5 months vs 12.4 months,P=0.037).Compared with the low LQI group,the age,level of alanine aminotransferase(ALT),aspartate transaminase(AST),prothrombin time(PT),total bilirubin(TBIL)and alpha fetoprotein(AFP)and rate of portal vein tumor thrombus and conservative therapy were lower,and the level of albumin(ALB),Barcelona Clinic Liver Cancer(BCLC)stage were higher in the high LQI group(P<0.05).Univariate analysis showed that the prognosis was correlated with ALB,AFP,Child-Pugh classification,portal vein tumor thrombus,extrahepatic metastasis,BCLC stage,conservative therapy and LQI(P<0.05).Multivariate analysis showed that AFP≥400 ng/ml,BCLC C stage and drug conservative therapy were independent risk factors for prognosis(P<0.05),while without portal vein tumor thrombus,without extrahepatic metastasis and LQI≥0.63 were independent protective factors(P<0.05).Conclusion:The life quality of the elderly patients with middle and advanced liver cancer is low.The lower the life quality,the worse the prognosis.