老年食道癌患者生存质量评估及影响因素

目的 分析老年食道癌患者的生存质量及其影响因素.方法 采用自制一般资料问卷收集153例老年食道癌患者的一般资料,主要包括性别、年龄、职业、文化程度、月收入、婚姻状况、城乡分布情况、临床分期等,采用欧洲癌症研究与治疗组织(EORTC)制定的癌症患者生命质量测定量表(EORTC QLQ-C30)评估食道癌患者的生存质量.比较老年食道癌患者与常模的EORTC QLQ-C30各项评分,分析老年食道癌患者生存质量的影响因素.结果 共收回有效问卷150份,有效回收率为98.04%.老年食道癌患者的EORTC QLQ-C30中功能量表及总体生存质量的得分均显著低于常模,症状量表及单项量表的得分均显著高于常模(P<0.05).单因素分析显示性别、职业、婚姻状况、城乡分布情况不是老年食道癌患者生存质量的影响因素(P>0.05),而年龄、文化程度、月收入、临床分期是老年食道癌患者生存质量的影响因素(P<0.05);Logistic回归分析显示,年龄越大、临床分期越高是老年食道癌患者生存质量降低的危险因素,而文化程度和月收入越高则是老年食道癌患者生存质量降低的保护因素(P<0.05).结论 老年食道癌患者术前的生存质量较差,年龄、文化程度、月收入、临床分期是主要的影响因素,临床应根据其影响因素给予适当的干预.     

老年2型糖尿病患者生存质量及其影响因素分析

目的 评价老年2型糖尿病患者的生存质量，并对相关影响因素进行分析。方法 采用生存质量综合评定问卷-74(GQOLI-74)对145例老年2型糖尿病患者的生存质量进行评价研究，运用单因素Kruskal-Wallis检验和多元逐步回归等统计方法对相关影响因素进行分析．结果 老年2型糖尿病患者生存质量普遍较低，生理功能的受损程度最大，心理功能受损最小。社会因素、医学因素和中医证候均对生存质量有显著影响。结论 应对城市低收入患者的生活提供关怀及帮助，建立相应的医疗优惠政策，老年患者应定期测血压，把控制血压作为防治2型糖尿病发生和发展的重要措施之一，对中医证候与生存质量的研究有助于更好地进行综合防治施治，提高老年2型糖尿病患者的生存质量。     

老年喉癌患者术后远期疗效及生存质量的影响因素

目的分析老年喉癌患者术后远期疗效及生存质量的影响因素。方法选择136例老年喉癌术后患者,对其进行为期5年随访,分析患者5年生存率,并对可能影响患者5年生存率的因素进行单因素及多因素Logistic回归分析。对术后5年生存患者进行汉化华盛顿生存质量问卷(UW-QOL)访谈式自评法进行调查,并对可能影响患者生存质量的各因素进行单因素及多因素Logistic回归分析。结果136例老年喉癌患者,术后随访5年生存率为59.56%(81/136)。对可能影响患者术后远期疗效因素进行单因素及多因素Logistic回归分析,结果显示,TNM分期、淋巴结转移、原发部位、治疗方式进入Logistic回归模型。对可能影响患者术后远期生存质量各因素进行单因素及多因素Logistic回归分析,结果显示,TNM分期及年龄进入Logistic回归模型。结论应对影响老年喉癌患者术后远期疗效的重要因素给予足够的重视,拟定适宜的治疗方案,以期提高患者生存率及生活质量。     

食管癌患者术后生存质量的影响因素

目的探讨老年食管癌患者术后生存质量的影响因素。方法选择98例行食管癌根治术的老年患者为食管癌组,再选择同期来院健康体检的60例健康对照组,比较分析两组生存质量,并对可能影响食管癌患者术后生存质量的各因素进行单因素和多因素Logistic回归分析。结果食管癌各维度生活质量评分以及总分均显著低于健康对照组(P<0.05)。单因素分析显示,食管癌患者胃食管反流、婚姻状况、家庭人均月收入、合并基础疾病、医疗方式、社会支持、居住状况、抑郁及焦虑与其生存质量明显相关(P<0.05);社会支持、家庭人均月收入、焦虑、抑郁及医疗方式进入Logistic回归模型(P<0.05),为影响老年食管癌患者术后生存质量的重要因素。结论老年食管癌患者术后生存质量低于一般老年人群,提高患者社会支持、尽可能减轻患者经济负担、给予患者更多的心理治疗有助于提高其生存质量。     

住院老年甲状腺功能亢进患者生存质量现况及影响因素

目的探讨住院老年甲状腺功能亢进(甲亢)患者生存质量状况及相关影响因素。方法采用世界卫生组织普遍采用的生存质量测定量表(WHOQOL-BREF)对在广东医学院附属医院住院的112例老年甲亢患者进行问卷调查。结果住院老年甲亢患者生理、心理、社会关系及环境领域得分分别为(58.61±13.27)、(57.40±11.91)、(60.24±14.68)和(52.61±13.98)分。生理领域、心理领域、社会关系领域及环境领域生存质量得分高文化程度患者高于低文化程度患者(P0.05),未婚患者高于已婚或离婚患者(P0.05);生理领域、环境领域生存质量得分高收入患者高于低收入患者(P0.05);Logistic回归分析显示性别、职业、文化程度是住院老年甲亢患者生存质量自我综合评分的影响因素(P0.01)。结论住院老年甲亢患者生存质量整体偏低,性别、职业、文化程度等是住院老年甲亢患者生存质量的影响因素。     

护理干预对癌症患者生存质量影响的研究进展

生活质量（QualityofLife，QOL）又被称为生存质量或生命质量。现常用生存质量来评价医疗、护理服务的效果。它从主要从生理、心理、社会功能三方面进行评估。近年来癌症患者生存期显著延长，患者的生活质量越来越受到关注，许多学者开展了对癌症患者生存质量的调查，通过分析不同阶段的调查结果，评估各种治疗效果。我国从20世纪90年代开始对癌症患者生活质量进行研究。本文就护理干预对癌症患者生存质量的影响进行如下综述。     

老年消化道癌症患者自我隐瞒、自尊状况及其影响因素

目的了解老年消化道癌症患者自我隐瞒、自尊状况及其影响因素。方法便利抽取146例老年消化道癌症患者,采用自我隐瞒量表(SCS)与自尊量表(SES)进行测评。结果老年消化道癌症患者自我隐瞒得分为(26.76±8.71)分,自尊得分为(29.22±4.74)分。多重线性回归分析显示自我隐瞒的影响因素有居住状况、化疗时期;自尊的影响因素有家庭收入、癌症分期。结论老年消化道癌症患者存在一定的自我隐瞒与低自尊,并受多种因素的影响,临床人员应了解其自我隐瞒与自尊状况,从不同视角进行干预来提高患者的自尊状况和生活质量。     

金华市某三级医院老年功能性消化不良患者生存质量及其影响因素分析

背景老年功能性消化不良(functional dyspepsia, FD)是临床常见疾病之一,多以中老年患者为主.目前认为精神心理因素导致的躯体化是影响老年FD生存质量的危险因素.由于我国医疗资源分布不平衡,对老年FD患者生存质量认识不足,再加上很多患者症状可能较轻,自身对疾病缺乏正确认识,对其生存质量的影响因素进行分析尤为必要.目的旨在探讨金华市某三级医院老年FD患者生存质量及其影响因素分析.方法选择2017-06/2019-08在我院就诊的134例老年FD患者为研究对象.采用生存质量量表、精神心理状况量表及健康行为自我效能量表卷进行测评,并分析老年FD患者生存质量的影响因素.结果老年FD患者功能性消化不良生存质量量表(functional digestive disorder quality of life questionnaire,FDDQL)总分为57.62分±8.16分,其中日常活动得分为75.48分±7.23分,受损最轻;健康感觉得分为45.61分±9.57分,受损最严重;其次疾病控制得分为47.38分±10.36分.不同性别、焦虑自评量表(self-rating anxietyscale,SAS)评分、抑郁自评量表(depression self-ratingscale,SDS)评分、自我效能、体质指数(bodymassindex,BMI)、饮酒史、病程、居住情况、症状严重程度、自我调节情绪及是否规律运动等FDDQL得分比较,差异有统计学意义(P0.05,或P 0.01);不同BMI患者FDDQL得分比较,差异无统计学意义(P0.05).老年FD患者的性别、自我效能、B M I、饮酒史、病程、居住情况及规律运动等与FDDQL呈正相关(r=0.147-0.215, P 0.05);老年FD患者的SAS、SDS评分,症状严重程度及自我调节等与FDDQL呈负相关[r=-0.765-(-0.284), P 0.05].通过多元回归分析发现,焦虑、症状严重程度、病程、自我效能和抑郁是老年FD患者生存质量的影响因素.结论老年FD患者生存质量影响因素较多,而焦虑、症状严重程度、病程、自我效能和抑郁是重要危险因素,在临床工作中应通过上述影响因素采取合理的干预以提高患者生存质量.     

术前血清γ-谷氨酰转肽酶水平对老年肝细胞癌患者行肝动脉化疗栓塞术后预后的影响分析

目的 探究术前血清γ-谷氨酰转肽酶(GGT)水平对老年肝细胞癌(HCC)患者行肝动脉化疗栓塞术(TACE)术后预后的影响因素。方法 回顾性分析2016年1月—2019年12月在成都市公共卫生临床医疗中心接受治疗的272例老年HCC患者的临床资料，将其中进行TACE的89例患者作为观察组，未进行TACE的183例患者作为对照组。根据既往的研究，选择可能与生存有关的临床病理因素，进行单因素和多因素Cox分析，以识别总体生存的独立预测因素。结果 单变量分析结果显示，总胆红素>20.4 mmol/L(HR=1.52,P=0.015)、 GGT>54 U/L(HR=2.02,P<0.001)、区域淋巴结转移(HR=1.58,P=0.014)和ES级Ⅲ～Ⅳ(HR=1.50,P=0.007)是与HCC老年患者术后生存时间相关的可能因素。在血清GGT水平≤54 U/L的患者中，ES分级Ⅲ～Ⅳ(HR≤1.94,P≤0.030)是生存的唯一重要危险因素。观察组和对照组患者术后生存时间差异无统计学意义(中位生存时间分别为38个月和26个月，P=0.818)。TACE不是与生存相关的独立变量...     

上海市某中心社区癌症患者生活质量评估与影响因素分析

目的通过对某中心城区158例癌症患者的调查分析,对社区癌症患者的生活质量进行评估并对相关影响因素进行分析。方法对158例癌症患者采用欧洲癌症研究与治疗组织生活质量核心评定量表（EORTCQLQ—C30．V3．0）及自设一般情况调查表进行问卷调查。结果癌症患者的躯体功能、角色功能、认知功能、社会功能低于Norwegian常模,另外在症状和单项比较中呼吸困难、失眠、便秘、经济困难评分也高于Norwegian常模。患者性别、学历和经济收入对生存质量影响差异无统计学意义,但患病时间和年龄的影响差异有统计学意义（P〈0．05）。结论癌症患者的生活质量受到患病时间和年龄的影响,社区医护人员在对社区肿瘤患者的随访过程中,不但要重视患者躯体症状的改善,还要加强心理、社会功能的改善,积极做好患者及家属的健康教育、心理疏导和行为干预等指导工作,以提高和促进社区肿瘤患者的生活质量。     

Prognostic factors in 165 elderly colorectal cancer patients

AIM: To analyse the prognostic factors in 165 colorectapatients aged ≥70.METHODS: One hundred and sixty-five elderly patients with colorectal cancer diagnosed by histology were entered into the retrospective study between 1994 and 2001. Patients were given optimal operation alone, chemotherapy after operation, or chemotherapy alone according to tumor stage,histology, physical strength, and co-morbid problems.Survival rate was calculated by Kaplan-Meier method, and compared with meaningful variances by Log-rank method.Prognostic factors were analyzed by Cox regression. RESULTS: The 1,2,3,4,5 year survival rate (all-cause mortality) was 87.76 %, 65.96 %, 52.05 %, 42.77 %, 40.51%, respectively. The mean survival time was 41.89&#177;2.33 months (95 % CI: 37.33-46.45 months), and the median survival time was 37 months. Univariate analysis showed that factors such as age, nodal metastasis, treatment method, Duke‘‘s stage, gross findings, kind of histology, and degree of differentiation had influences on the survival rate. Multivariate analysis showed that factors such as treatment method, Duke‘‘s stage, kind of histology and degree of differentiation were independent prognostic factors. CONCLUSION: This study suggests that the prognosis of elderly colorectal cancer patients is influenced by several factors. Most of elderly patients can endure surgery and/or chemotherapy, and have a long-time survival and good quality of life.     

Survival rate of pancreatic cancer in elderly patients

BACKGROUND/AIMS: As the population ages, many elderly people will be diagnosed with pancreatic cancer. This study is to investigate the current survival rates for patients aged > or = 70 years diagnosed with pancreatic cancer and to identify prognostic factors, which will help in choosing optimal therapies for individual patients. METHODOLOGY: Information was gathered retrospectively for 81 patients aged > or = 70 years with pancreatic cancer. Clinical parameters, treatments received and survival curves from initial treatment were analyzed. RESULTS: Overall median survival was 6.2 months. Patients who underwent surgical therapy had the best median survival rate of 26.5 months, followed by patients receiving chemotherapy (6.6 months), chemoradiotherapy (5.7 months) and best supportive care (3.4 months). Further analysis showed that the median survival of chemotherapy and chemoradiotherapy groups was 8.1 and 11.3 months for stage III, 6.2 and 3.9 months for stage IV respectively. Independent negative prognostic factor for survival were Karnofsky performance status < or = 80 and presence of distant metastases. CONCLUSIONS: Long-term survival can be achieved through surgical resection in patients aged > or = 70 at early stage. Chemotherapy should be considered for patients with better expected survival. Radiation therapy should be applied for stage III patients. However, it was not associated with survival benefit for stage IV. Karnofsky performance status and distant metastases are independent prognostic factors.     

乳腺癌患者接受术后辅助化疗的影响因素分析

目的 探讨65岁以上乳腺癌患者接受术后辅助化疗的影响因素. 方法 采用χ2检验和Logistic回归分析方法对590例65岁以上浸润性乳腺癌患者术后辅助化疗的影响因素进行分析. 结果 全组接受术后辅助化疗者231例,占39.15%.结果表明,并存糖尿病、年龄、手术方式及肿瘤的病理生物学特征对患者接受术后辅助化疗有影响(χ2值分别为4.49、88.27、23.49及9.40,均为P<0.05).Logistic回归分析结果显示.年龄、术后病理肿瘤最大径(pT)、术后病理淋巴结状况(pN)、雌激素受体(ER)对接受术后辅助化疗有影响(χ2值分别为68.857、15.284、43.540、7.009,均为P<0.01).淋巴结阳性激素受体阴性的患者中44例(66.7%)接受了术后辅助化疗. 结论 肿瘤大小、淋巴结状况、激素受体状况和年龄是老年乳腺癌患者接受术后辅助化疗的独立预测因素.     

中西医结合治疗190例老年胰腺癌的预后分析

目的通过临床回顾性研究对以清胰化积方为主的中西医综合治疗老年胰腺癌进行疗效评估,探讨可行性治疗模式。方法采用Kaplan-Meier方法计算生存期,Log-rank检验进行组间比较,并通过应用Cox比例风险模型对2002年1月至2008年12月期间接受中西医结合治疗的190例老年胰腺癌患者进行多因素分析。结果本组190例老年胰腺癌患者:1年生存率28.42%;3年生存率6.32%;5年生存率2.11%。中位生存期为7.1个月。其中清胰化积组102例,中位生存期8.7个月;非清胰化积方88例,中位生存期4.7个月,差异有统计学意义(P0.05)。KPS评分80、CA19-9≥500 U/ml、消瘦(体重在6个月内减轻≥10%)、肝转移、手术方式、全身化疗和清胰化积中药是影响该治疗模式预后的独立影响因子。结论根治手术、全身化疗和清胰化积中药是老年胰腺癌长期生存保护因素。老年胰腺癌Ⅲ期患者可化疗结合清胰化积方中药治疗,Ⅳ期老年胰腺癌患者则应以中药及最佳对症支持治疗为主。     

Nutritional status and quality of life of the gastric cancer patients in Changle County of China

AIM: To analyze the relation between nutrition and quality of life in the stomach cancer patients, evaluate the intake of daily nutrition of the patients, and study the feasibility of nutrition intervention in improving quality of life of the stomach cancer patients. METHODS: A total of 285 surgical stomach cancer patients reported in the Changle Cancer Registry from 2002 to 2003 were investigated with respect to their diet and quality of life. Daily nutrition intakes of the patients were calculated according to the Food Composition Database, and these data were compared with the reference values proposed by the Chinese Nutrition Society. The partial correlation was used to analyze the relationship between nutrition and quality of life in the patients. Stepwise multiple regression analyses were conducted to analyze the factors influencing nutrition intake in stomach cancer patients. RESULTS: Except vitamin C, there were statistical correlations between the nutrition and quality of life in stomach cancer patients, and differences of the daily nutrition intake among three groups (good, modest and bad quality of life) of the patients were significant. Most of the stomach cancer patients had a lower daily nutrition intake than the reference values. At the significance level α=0.05, the factors influencing the daily nutrition intake of the patients were number of meals a day, family income, way of operation, exercise and age. CONCLUSION: The nutritional status of the operated patients with stomach cancer may impact on their quality of life. The stomach cancer patients in Changle County have a low level of daily nutrition intake, which suggests that they have a bad nutritional status. To improve the quality of life of the patients, the nutrition intervention should be conducted. Increasing times of meals a day and having a high-protein, high-calorie foods can improve the nutritional status of the stomach cancer patients. Moreover, exercise for rehabilitation can whet the appetite of the patients and recover their body function, which in turn may improve the quality of life of the stomach cancer patients.     

Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases

BACKGROUND/AIMS: The prognosis ofhepatocellular carcinoma with macroscopic portal vein tumor thrombosis is extremely poor. The risk factors may differ at different postoperative intervals. This study was undertaken to clarify the surgical outcome and time dependency of factors influencing survival in these patients. METHODOLOGY: We analyzed clinicopathological variables of 381 hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis who underwent hepatic resection. Survival rates were calculated using Kaplan-Meier method. The stratified Cox models were used to identify factors independently influencing short- and long-term survival, respectively. RESULTS: The cumulative 1-, 2-, 3-, 5-, and 10-year survival rates in 381 patients were 47%, 23%, 16%, 12%, 6%, respectively. The 1-, 3-, and 5-year survival rates calculated from time of re-resection were 36%, 14% and 0% in patients undergoing re-resection for intrahepatic recurrence within 2 years after first operation, and 85%, 53% and 32% in those more than 2 years after first operation (P<0.05). Multivariate analysis showed that portal vein infusion chemotherapy, serum alpha-fetoprotein > 20 mg/L and positive surgical margin were significant prognostic factors within 2 years after operation. In contrast, alanine aminotransferase > 80 U/L was the only significant factor beyond 2 years after operation. CONCLUSIONS: The survival of hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis was poor, but the prognosis of patients who had tumor recurrence more than 2 years after operation was much better than those with tumor recurrence within 2 years. Evaluation of time-dependency of risk factors may have important clinical implication in determining the therapeutic strategy.     

Survival analysis according to treatment modality in pancreatic cancer patient]

BACKGROUND/AIMS: Pancreatic cancer is the 5(th) leading cause of cancer death in Korea and its incidence is increasing. At present, surgical resection offers the best chance of cure. However, most of pancreatic cancers are already unresectable at initial diagnosis. Thus, the majority of patients depend on chemotherapy, radiotherapy, or supportive care. We investigated the effect of treatment modalities on the survival in pancreatic cancer. METHODS: Between September 1994 and May 2003, one hundred and fifty four patients with pancreatic cancer were treated by surgery, radiotherapy, chemotherapy or conservative management. The clinical datas were analyzed retrospectively for survival according to stage and treatment modality. RESULTS: Overall median survival time was 5.7 months and 1 year survival rate was 18.3%. In patients with stage I to III disease, the median survival time was 13.9 months in surgery group, 10.2 months in radiation group, and 6.1 months in supportive care group (p%lt;0.01). Survival rate according to treatment modality was significantly different among groups. In patients with stage IV disease, the median survival time was 6.1 months in radiation therapy group, 7.1 months in chemotherapy group, and 2.7 months in supportive care group. Overall survival was significantly higher in treatment groups than in supportive care group (p<0.01), but there was no difference in survival between chemotherapy group and radiotherapy group. CONCLUSIONS: In patients with stage I to III pancreatic cancer, surgery can improve median survival. In patients with stage IV, either chemotherapy or radiotherapy can prolong survival compared to supportive care. These results suggest that more active treatment of pancreatic cancer even in advanced stage will be needed to prolong the survival.     

40岁以下肺癌病人放疗与化疗疗效分析

目的探讨40岁以下失去手术机会的肺癌病人放疗与化疗的疗效及影响预后因素。方法103例40岁以下病人单纯化疗45例，化疗与放疗综合治疗54例，单纯放疗4例。结果103例中CR23．3％（24／103），总有效率75．73％。1、2、5年生存率分别为52．37％、29．87％、7．8％，中位生存期15个月。结论放疗与化疗综合治疗疗效优于单一方法治疗；血清CEA、误诊及机体免疫功能为影响愈后的重要因素。     

164例小细胞肺癌术后预后分析

目的探讨术后小细胞肺癌（SCLC）生存率的影响因素。方法对经手术治疗后确诊为小细胞肺癌的164例患者进行长期随访,并对患者术后生存率有影响的因素进行分析。结果Ⅰ、Ⅱ与Ⅲ期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;手术切除＋术后化疗组和单纯手术组比较,1年、3年生存率间差异有显著统计学意义（P〈0.01）,两组在TNM分期下Ⅰ、Ⅱ、Ⅲa期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;术式（肺全切和肺叶切）、年龄（〈60岁和≥60岁）和性别（男性和女性）1年、3年、5年生存率间差异无显著意义（P〉0.05）。结论 TNM分期、术后有无化疗对患者术后生存率有明显影响。     

Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment

Background

Several database studies report a lack of care in elderly patients with colorectal cancer.

Purpose

To describe the management of elderly patients admitted for colorectal cancer; to identify factors associated with standard management according to recommendations and to study factors influencing the survival.

Patients and methods

All consecutive patients over 75 years managed for a colorectal adenocarcinoma in our hospital from 1995 to 2000 and followed until 2006 were retrospectively included. The appropriateness of the management of their disease according to the recommendations available at that time was assessed. Several risk factors in receiving the standard cancer treatment were tested using univariate and then multivariate logistic regression. Risk factors of survival were studied using univariate and then multivariate survival analysis.

Results

One hundred and ten patients were included. Median age was 82 years (range: 75-96). A surgical treatment was performed in 96 patients. The median overall survival was 32 (1-108) months. A standard cancer treatment according to recommendations was performed in 53 (48%) patients: adjuvant chemotherapy in 6/23 patients with stage III tumour, palliative chemotherapy in 3/18 patients with stage IV tumour and adjuvant radiotherapy in 4/14 patients who had a rectal tumour resection. Multivariate analysis retains tumour stage I or II (OR = 7.6, 95% C.I. = [2.9-19.9], p < 0.0001) as the only factor associated with standard treatment and presence of metastasis (HR = 3.9, 95% C.I. [1.4-10.8], p = 0.005), and Charlson's score >3 (HR = 28.9, 95% C.I. [2.5-335.6], p = 0.001) as independent risk factors of poor survival.

Conclusions

Fifty two percent of elderly patients have had a sub-standard cancer treatment. The majority had a surgical treatment, but only a few received chemotherapy or radiotherapy. Metastasis, older age and Charlson's comorbidity score are the main prognosis factors of poor survival.