原发性肝癌患者介入治疗前后生命质量评价及影响因素分析（多中心研究）
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摘要
背景：介入治疗作为原发性肝癌首选的非手术疗法，可以有效地提高患
者的中位生存期及1～5年生存率。但在临床工作中，我们经常发现部分
患者在延长生命数量的同时，其生命质量并没有得到相应的改善，甚至
还出现明显的下降。介入治疗对于原发性肝癌患者的生命质量影响究竟
如何？影响因素包括哪些？对这些问题目前国内外尚未见有文献报道。
有必要从生命质量对其进行评价，以期解释上述问题，并为选择适当的
介入治疗技术以提高中晚期肝癌患者的生命质量打下基础。目的：了解
原发性肝癌患者介入治疗前的生命质量和术后变化情况，分析各影响因
素，在此基础上探讨肝癌患者的生命质量分型标准和各种因素对其的影
响。材料与方法：搜集广东省三家医院175例经介入治疗的原发性肝癌
患者的临床资料。采用万祟华等编制的肝癌特异性评定量表（总分为220
分），以面对面问卷调查形式，于介入术前、术后1月及3月对研究对象
进行生命质量评定，对其影响因素进行单因素及多因素逐步回归分析。
归纳介入期间生命质量变化曲线类型，并以此为标准对肝癌患者进行生
命质量分型。结果：生命质量总分平均值术前、术后1月及3月分别为：
115.4±45.1、128.1±28.3、129.8±46.4（p＜0.01）。单因素分析显示有意义
的影响因素是肝癌分期、肝功分级、肿瘤大小、生长方式、门脉侵犯、
有否栓塞、有否超选择性插管治疗（简称超选）及介入次数（p＜0.01）。
多因素逐步回归分析示肝癌分期、肝功分级、有否超选、有否栓塞及介
入次数是影响患者生命质量得分的主要因素（p＜0.05）。采用频数曲线交
叉的方法对肝癌患者进行生命质量分型：术前得分高于150者为Ⅰ型，
变化曲线为下降恢复型；位于89和143之间者为Ⅱ型，其生命质量变化
曲线为持续上升型；术前得分低于89者为Ⅲ型，变化曲线为上升下降型。
结论：总体上介入治疗能够提高中晚期肝癌患者的生命质量。提高程度
与患者一般状况、肿瘤发展程度和介入治疗方法等密切相关。生命质量
评价有望成为肝癌介入治疗效果评价的一种新途径。
Evaluation of Quality of Life Pre and Post Interventional Therapy in
Patients with Primary Hepatocellular Carcinoma and Analysis of the
Affected Factors: Multiple Center Investigation
Postgraduate Zhao Jianbo
Tutor prof Li Yanhao
ABSTRACT
BACKGROUND: Interventions] therapy (IVT) can effectively increase the survival time of the patients with hepatocellular carcinoma (HCC) and was regarded as the preferred non-operation therapeutic method. But in clinical practice, it was usually found that the survival time was prolonged in most HCC patients, meanwhile, their quality of life (QOL) could not be improved, sometimes going down. So the questions are how do IVT affect QOL on earth and what are these affected factors? It is necessary to evaluate HCC patient抯 QOL undergoing IVT, so as to improve their QOL. OBJECTIVE:
To evaluate QOL pre and post IVT in the patients with HCC and to analyse the affected factors. Based on the results, to establish the QOL classification of HCC patients. MATERIALS and METHODS: A QOL questionnaire specially for HCC patients (completed by Chonghua Wan) was used to investigate by face to face method in 175 HCC patients undergoing IVT from 3 hospitals of Guangdong province. The investigation time was pre-IVT~ post-IVT 1 and 3 months. The main affected factors of QOL were analysed by univariate and multivariate analysis. The variational curve of QOL during the investigation time was induced and the QOL classification was established. RESULT: The average scores were respectively 115.4+45.1 (pre IVT).. 128.1+28.3.. 129.8+46.4 (post IVT 1 and 3 months) (p
mode~. tumor invasion in port veinN hepatic artery chemoembolization or not~. superselective catheterization or not and [VT times were significant factors in follow-up (p chemoembolization or not and IVT times were the most significant factors
1.
(p The QOL scores pre-IVT between 89 and 143 were classified as QOL type II and variational curve was constantly ascending. The scores morethan 150 were QOL type I and its curve was slack recovering. Scores below 83 were QOL type III and the curve was ascending to decending. CONCLUSION: Totally, the QOL of HCC patients was obviously improved after IVT. But the improvements are closely related with the general condition of patients, the degree of tumor invasion and the managements. It is suggested that the evaluation of QOL may be an effective means to assess the curative effect.
者的中位生存期及1～5年生存率。但在临床工作中，我们经常发现部分
患者在延长生命数量的同时，其生命质量并没有得到相应的改善，甚至
还出现明显的下降。介入治疗对于原发性肝癌患者的生命质量影响究竟
如何？影响因素包括哪些？对这些问题目前国内外尚未见有文献报道。
有必要从生命质量对其进行评价，以期解释上述问题，并为选择适当的
介入治疗技术以提高中晚期肝癌患者的生命质量打下基础。目的：了解
原发性肝癌患者介入治疗前的生命质量和术后变化情况，分析各影响因
素，在此基础上探讨肝癌患者的生命质量分型标准和各种因素对其的影
响。材料与方法：搜集广东省三家医院175例经介入治疗的原发性肝癌
患者的临床资料。采用万祟华等编制的肝癌特异性评定量表（总分为220
分），以面对面问卷调查形式，于介入术前、术后1月及3月对研究对象
进行生命质量评定，对其影响因素进行单因素及多因素逐步回归分析。
归纳介入期间生命质量变化曲线类型，并以此为标准对肝癌患者进行生
命质量分型。结果：生命质量总分平均值术前、术后1月及3月分别为：
115.4±45.1、128.1±28.3、129.8±46.4（p＜0.01）。单因素分析显示有意义
的影响因素是肝癌分期、肝功分级、肿瘤大小、生长方式、门脉侵犯、
有否栓塞、有否超选择性插管治疗（简称超选）及介入次数（p＜0.01）。
多因素逐步回归分析示肝癌分期、肝功分级、有否超选、有否栓塞及介
入次数是影响患者生命质量得分的主要因素（p＜0.05）。采用频数曲线交
叉的方法对肝癌患者进行生命质量分型：术前得分高于150者为Ⅰ型，
变化曲线为下降恢复型；位于89和143之间者为Ⅱ型，其生命质量变化
曲线为持续上升型；术前得分低于89者为Ⅲ型，变化曲线为上升下降型。
结论：总体上介入治疗能够提高中晚期肝癌患者的生命质量。提高程度
与患者一般状况、肿瘤发展程度和介入治疗方法等密切相关。生命质量
评价有望成为肝癌介入治疗效果评价的一种新途径。
Evaluation of Quality of Life Pre and Post Interventional Therapy in
Patients with Primary Hepatocellular Carcinoma and Analysis of the
Affected Factors: Multiple Center Investigation
Postgraduate Zhao Jianbo
Tutor prof Li Yanhao
ABSTRACT
BACKGROUND: Interventions] therapy (IVT) can effectively increase the survival time of the patients with hepatocellular carcinoma (HCC) and was regarded as the preferred non-operation therapeutic method. But in clinical practice, it was usually found that the survival time was prolonged in most HCC patients, meanwhile, their quality of life (QOL) could not be improved, sometimes going down. So the questions are how do IVT affect QOL on earth and what are these affected factors? It is necessary to evaluate HCC patient抯 QOL undergoing IVT, so as to improve their QOL. OBJECTIVE:
To evaluate QOL pre and post IVT in the patients with HCC and to analyse the affected factors. Based on the results, to establish the QOL classification of HCC patients. MATERIALS and METHODS: A QOL questionnaire specially for HCC patients (completed by Chonghua Wan) was used to investigate by face to face method in 175 HCC patients undergoing IVT from 3 hospitals of Guangdong province. The investigation time was pre-IVT~ post-IVT 1 and 3 months. The main affected factors of QOL were analysed by univariate and multivariate analysis. The variational curve of QOL during the investigation time was induced and the QOL classification was established. RESULT: The average scores were respectively 115.4+45.1 (pre IVT).. 128.1+28.3.. 129.8+46.4 (post IVT 1 and 3 months) (p
mode~. tumor invasion in port veinN hepatic artery chemoembolization or not~. superselective catheterization or not and [VT times were significant factors in follow-up (p
1.
(p
引文
1 颜江瑛，刘筱娴。生命质量—健康评价的发展方向。国外医学社会医学分册，1999，16(1)：7-10
2 张立力，张振书，严金海。和存质量研究与医学模式的转变。医学与哲学，1998，19(7)：368-369
3 蔡善荣，李鲁。健康相关生命质量的研究概况。国外医学社会医学分册，1999，16(1)：4-7
4 罗健，孙燕。癌症患者的生活质量研究(二)。中国肿瘤，1995，4(11)：21-25
5 汤旦林，王松柏。生存质量测定及其在临床试验中的应用。中华医学杂志，1994，74(3)：175-179
6 李君荣，周有尚。用生命质量测定评价慢性疾病。中国卫生统计，1994，11(1)：54-57
7 万崇华，方积乾，张灿珍，等。肝癌患者生存质量测定量表的制定与考评。中国行为医学科学，1998，7(3)：170-173
8 陈勇，马富，李彦豪。经锁骨下入路锁骨下动穿刺插管的应用解剖。中国临床解剖杂志，1999，17(1)：64-65
9 李彦豪，罗鹏飞，黄信华，等。经皮锁骨下动脉导管药盒系统植入术。中华放射学杂志，1995，29(8)：551-552
10 陈灏珠，主编。内科学(第四版)。北京：人发卫生出版社，1996：414
11 李麟荪 主编。临床介入诊疗学(第1版)。南京：江苏科学技术出版社，1994：325
12 陈和年，胡孟璇。有关Quality of Life一词的中文表达。中华预防医学杂志，1998，30(1)：53
13 罗健，孙燕。癌症患者的生活质量研究(一)。中国肿瘤，1995，4(10)：15-19
14 陈和年，方积乾，胡孟璇。生存质量研究。中华预防医学杂志，1993，27(3)：178-180
15 汪凯。生命质量、生命数量与健康。医学与哲学，1998，19(4)：192-194
16 Yamamaoto K, Masuzawa M, Kato M, et al. Analysis of prognostic factors in patients with hepatocellular carcinoma treated by transcatheter embolization. CCP, 1992,31:577
17 Hsieh MY, Chuang WY, Wang LY, et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization and analysis of prognostic factors. CCP, 1992; 31:S82
18 Klamut-M, Szczerbo-Trojanowska-M, Rakowski-P, et al. Embolization of the hepatic artery in the treatment of liver neoplasm. Pol-Przegl-Radiol, 1987; 51(1):44-49
19 Gramov-AM, Tarazov-PG. The preoperative embolization of the hepatic artery in patients with malignant liver trmors. Vopr-Onkol, 1990; 36:1189-11916
20 贾雨辰，刘崎，贺佳，等。Cox模型对肝癌预后因素的分析。介入放射学杂志，1996，5(1)：7-11
21 王建华，王小林，颜志平，主编。腹部介入放射学(第1版)。上海：上海医科大学出版社，1998：59
22 林贵，王建华，顾正明，等。肝动脉化疗栓塞治疗中、晚期肝癌的疗效和影响因素。中华放射学杂志，1992，26：311
23 刘崎，田建明，贾雨辰，等。肝癌并门脉主干癌栓的介入治疗及其预后的影响因素。中华放射学杂志，1999，33(8)：538-541
24. Jenney-ME, Kane-RL, Lurie-N, et al. Developing a measure of health
outcomes in survivors of childhood cancer: a review of the issues. Med-Pediatr-Oncol, 1995 Mar; 24(3) : 145-53
25． Levi-L. Psychosocial environmental factors and Psychosocially mediated effects of physical environmental factors. Scand-J-Work-Environ-Health, 1997; 23 suppl 3: 47-52
26． WHO. Report of the WHO Meeting on the Assessment of Quality of life in the Heath Care. WHO, 1991．
27． Hollen PJ,Gralla-RJ. Comparison of instruments for measuring quality of life in patients with lung cancer. Semin-Oncol, 1996 Apr; 23(2 suppl 5) : 31-40
28． Jacoby-A, Baker-GA, Steen-N, et al. The SF-36 as a health status measure for epilepsy: a psychometric assessment. Qual-Life-Res,1999 Jun; 8(4) : 351-64
29． Mchorney-CA, Ware-JE, Raczek-AE. The MOS 36-Item Short-Form health survey(SF-36) : II: Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med-care, 1993 Mar; 31(3) : 247-63
30． Aaronson-NK, Ahmedzai-S, Bergman-B, et al. The European Organezation for Research and treatnent of cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J-Natl-Cancer-inst. 1993 Mar 3; 85(5) : 365-76
31． Sneeuw-KC, Aaronson-MK, Sprangers-MA, et al. Comparison of patient and proxy EORTC QLQ-C30 ratings in assessing the quality of life of cancer patients. J-Clin-Epidemiol, 1998 Jul; 51 (7) : 617-31
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2 张立力，张振书，严金海。和存质量研究与医学模式的转变。医学与哲学，1998，19(7)：368-369
3 蔡善荣，李鲁。健康相关生命质量的研究概况。国外医学社会医学分册，1999，16(1)：4-7
4 罗健，孙燕。癌症患者的生活质量研究(二)。中国肿瘤，1995，4(11)：21-25
5 汤旦林，王松柏。生存质量测定及其在临床试验中的应用。中华医学杂志，1994，74(3)：175-179
6 李君荣，周有尚。用生命质量测定评价慢性疾病。中国卫生统计，1994，11(1)：54-57
7 万崇华，方积乾，张灿珍，等。肝癌患者生存质量测定量表的制定与考评。中国行为医学科学，1998，7(3)：170-173
8 陈勇，马富，李彦豪。经锁骨下入路锁骨下动穿刺插管的应用解剖。中国临床解剖杂志，1999，17(1)：64-65
9 李彦豪，罗鹏飞，黄信华，等。经皮锁骨下动脉导管药盒系统植入术。中华放射学杂志，1995，29(8)：551-552
10 陈灏珠，主编。内科学(第四版)。北京：人发卫生出版社，1996：414
11 李麟荪 主编。临床介入诊疗学(第1版)。南京：江苏科学技术出版社，1994：325
12 陈和年，胡孟璇。有关Quality of Life一词的中文表达。中华预防医学杂志，1998，30(1)：53
13 罗健，孙燕。癌症患者的生活质量研究(一)。中国肿瘤，1995，4(10)：15-19
14 陈和年，方积乾，胡孟璇。生存质量研究。中华预防医学杂志，1993，27(3)：178-180
15 汪凯。生命质量、生命数量与健康。医学与哲学，1998，19(4)：192-194
16 Yamamaoto K, Masuzawa M, Kato M, et al. Analysis of prognostic factors in patients with hepatocellular carcinoma treated by transcatheter embolization. CCP, 1992,31:577
17 Hsieh MY, Chuang WY, Wang LY, et al. Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization and analysis of prognostic factors. CCP, 1992; 31:S82
18 Klamut-M, Szczerbo-Trojanowska-M, Rakowski-P, et al. Embolization of the hepatic artery in the treatment of liver neoplasm. Pol-Przegl-Radiol, 1987; 51(1):44-49
19 Gramov-AM, Tarazov-PG. The preoperative embolization of the hepatic artery in patients with malignant liver trmors. Vopr-Onkol, 1990; 36:1189-11916
20 贾雨辰，刘崎，贺佳，等。Cox模型对肝癌预后因素的分析。介入放射学杂志，1996，5(1)：7-11
21 王建华，王小林，颜志平，主编。腹部介入放射学(第1版)。上海：上海医科大学出版社，1998：59
22 林贵，王建华，顾正明，等。肝动脉化疗栓塞治疗中、晚期肝癌的疗效和影响因素。中华放射学杂志，1992，26：311
23 刘崎，田建明，贾雨辰，等。肝癌并门脉主干癌栓的介入治疗及其预后的影响因素。中华放射学杂志，1999，33(8)：538-541
24. Jenney-ME, Kane-RL, Lurie-N, et al. Developing a measure of health
outcomes in survivors of childhood cancer: a review of the issues. Med-Pediatr-Oncol, 1995 Mar; 24(3) : 145-53
25． Levi-L. Psychosocial environmental factors and Psychosocially mediated effects of physical environmental factors. Scand-J-Work-Environ-Health, 1997; 23 suppl 3: 47-52
26． WHO. Report of the WHO Meeting on the Assessment of Quality of life in the Heath Care. WHO, 1991．
27． Hollen PJ,Gralla-RJ. Comparison of instruments for measuring quality of life in patients with lung cancer. Semin-Oncol, 1996 Apr; 23(2 suppl 5) : 31-40
28． Jacoby-A, Baker-GA, Steen-N, et al. The SF-36 as a health status measure for epilepsy: a psychometric assessment. Qual-Life-Res,1999 Jun; 8(4) : 351-64
29． Mchorney-CA, Ware-JE, Raczek-AE. The MOS 36-Item Short-Form health survey(SF-36) : II: Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med-care, 1993 Mar; 31(3) : 247-63
30． Aaronson-NK, Ahmedzai-S, Bergman-B, et al. The European Organezation for Research and treatnent of cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J-Natl-Cancer-inst. 1993 Mar 3; 85(5) : 365-76
31． Sneeuw-KC, Aaronson-MK, Sprangers-MA, et al. Comparison of patient and proxy EORTC QLQ-C30 ratings in assessing the quality of life of cancer patients. J-Clin-Epidemiol, 1998 Jul; 51 (7) : 617-31
32． Boutitie-F, Gueyffier-F, Pocock-SJ, et al. Assessing treatment-tine interaction in clinical trials with time to event data: a meta-analysis of
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