以前瞻性評估肝癌手術病人術前生活品質與術後死亡率之相關性：系統性回顧 & 統合分析

研究目的：隨著醫療的進步，癌症病患對於健康相關之生活品質日趨重視，根據研究顯示，手術病患的術前與術後生活品質優劣，對其預後能力有明顯的影響，而心理狀態亦會影響生活品質之狀況，以焦慮症狀、憂鬱症狀為普遍，然而肝癌更是國人十大惡性腫瘤之一。因此，本研究主要目的為評估肝癌病患健康相關生活品質各構面以及焦慮症狀和憂鬱症狀之長期改變趨勢，藉由生活品質問卷之術前構面分數預測術後的死亡率，並針對過去的相關文獻做統合分析。研究方法：本研究對象為南部三間教學醫院的肝癌手術病人，共有369位病患，其病患皆在術前、術後六月、術後一年以及術後二年完成癌症治療功能評估-肝膽(FACT-Hep)、歐洲組織癌症生活品質研究與治療問卷(EORCT QLQ-C30)、SF-36、貝克焦慮量表(BAI)、貝克憂鬱量表(BDI)。在生活品質問卷中，功能構面之分數愈高表示功能狀況愈好，症狀構面之分數愈高表示症狀愈嚴重，而貝克焦慮量表或貝克憂鬱量表之分數愈高表示焦慮症狀或憂鬱症狀愈嚴重。研究工具採用廣義估計方程式(GEE)進行趨勢分析，並針對肝癌手術病人術前生活品質與術後死亡率，進行系統性文獻回顧與統合分析。研究結果：本研究樣本平均年齡60歲(SD=10.9)，男性占73.7%。FACT-Hep：相較於術前，術後六月，在情緒穩定、一般癌症治療功能評估總分以及肝癌治療功能評估總分，顯著改善；相較於術後六月，術後一年在統計上所有構面皆無顯著差異；相較於術後一年，術後二年社會/家庭健全狀況以及肝膽癌附加事項，顯著較差。QLQ-C30：在整體生活品質上，隨著時間增加有整體下降的趨勢。SF-36：相較於術前，術後六月的一般自覺健康、活力狀況、社會功能、心理健康之構面有顯著改善。一般自覺健康之構面，其術後二年生活品質的分數顯著較差。BAI與BDI：在術後六個月皆有顯著改善。整體而言，當術前有較好的生活品質(角色功能與生理功能等)，術後死亡風險較低，且在統合分析當中，亦發現到當術前有較好的生理健全以及家庭/社會健全，其術後有較低的死亡率。結論與建議：當評估肝癌病患術前與術後健康相關生活品質之改變趨勢，由健康相關生活品質之量表中顯示出，健康相關生活品質在術後六月至術後一年皆有改善，但在術後兩年的分數卻相對低於術後一年，表示我們更應該關注肝癌病患在術後一年之生活品質狀況。肝癌病患須接受手術，當術前有良好的生理功能、角色功能並且給予家庭/社會的支持，將可以使病患在面對疾病時有較積極且正向的態度，亦可有較高的存活率。

關鍵字

肝癌；健康相關生活品質；焦慮症狀；憂鬱症狀；趨勢分析；存活率

並列摘要

Purpose: With the advance of medical care, health-related quality of life (HRQoL) becomes more and more imporntant of cancer patient. Therefor, this study purposed to assess health-related quality of life, anxiety and depression symptoms with longitudinal study for hepatocellular carcinoma (HCC) patients. First, a prospective cohort study was performed in a large database. Second, a systematic review and a meta-analysis of the relevant literature were performed. Research Methods: A total of 369 HCC sugery patients from three affiliated teaching hospitals in south-ern Taiwan were included in the study. HRQoLwas collected from the FACT Hepato-biliary (FACT-Hep), EORTC Quality of Life Questionnaire-C30 (QLQ-C30), Short Form-36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI- II) surveyed at baseline, postoperatively 6th month, 1st year and 2nd year. Gener-alized estimating equation (GEE) model was employed for trend analysis, and in con-junction with the prospective study, a systematic review and meta-analysis of the rel-evant literature also were performed. Result: The study is more common in men and average age of 60. In FACT-Hep, EORTC QLQ-C30 and SF-36 questionnaires were found patients’s physical function and syp-tom scale have singnificantly improved at 6 month after surgery, also finding overall quality of life become worse at 2 years after postoperative.Anxiety and depression symptom become better at 6 month of postoperative. Another finding that having better quality of life before preoperative (role function and physiological function, etc.) is low risk of dead after surgery. And in me-ta-analysis were also to have better physical well-being and family/social well-being which had a lower postoperative mortality. Conclusions and Recommendations: It showed a significant improvement of quality of life in HCC patient from the 6th month to the 2nd year after surgery. But the magnitude of improvement is less in the second year than that in the first year, which means more attention should be paid to quality of life in HCC patients one year after surgery. In addition, when HCC patient which maintaining good physical function, role function and giving family/social sup-port will be able to face disease with positive attitude, perhaps it can make you have a higher survival rate.