Acute Stage Longitudinal Change of Quality of Life from Pre- to 3 Months after Surgical Treatment in Head and Neck Cancer Patients

Purpose: Head and neck cancer (HNC) patients experience various posttreatment side effects that decrease quality of life (QOL). Some previous study reported that QOL of HHC patients were returned baseline (before treatment) after a year post treatment. However, acute stage longitudinal changes of QOL in HNC patients remains unclear. This point might be important for early reintegration of HNC patients. This study aimed to investigate the acute stage longitudinal change of the relationship between QOL and oral function in HNC patients had surgery. Methods: 45 HNC patients (23 men) scheduled for surgical treatment were enrolled in this study. Primary tumor sites were 22 tongue, 5 maxilla, 4 mandible, 3 pharynx and others. Weight, body mass index (BMI), whole body soft lean mass (SLM), and skeletal muscle mass (SMM) were evaluated as muscle mass-related measurements. Lip closure force (LC) and tongue pressure (TP) were evaluated as oral function measurements. Feeding function was evaluated using the Functional Oral Intake Scale (FOIS). QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaire QLQ-C30 and H&N 35. Measures were evaluated at pre-surgical treatment (PT), and 1 month (1M) and 3 months (3M) after surgery. The change of QOL parameters and relationships between measurements were assessed. Results: For QOL assessments, role functioning, fatigue, speech problems, trouble with social eating, trouble with social contact, and opening mouth significantly decreased from PT to 1M, but significantly increased from 1M to 3M. Weight, BMI, SLM, SMM, LC, TP, and FOIS demonstrated significant relationships with QOL from PT to 1M. Meanwhile, from 1M to 3M, weight, BMI, SLM, SMM, LC, and FOIS showed significant relationships with QOL assessments. Conclusions: Both oral function and muscle mass-related measurements significantly affected QOL in HNC patients.     

Ablation of advanced tongue or base of tongue cancer and reconstruction with free flap: functional outcomes.

AIM: To evaluate the functional outcomes of patients who underwent total or nearly total glossectomy for advanced tongue or base of tongue cancer. MATERIAL AND METHODS: We used the radial forearm free flap (RFFF), anterior lateral thigh flap (ALTF) or fibular osteocutaneous flap (FOCF) to reconstruct the oral defect after radical resection in 39 patients undergoing total or nearly total glossectomy with laryngeal preservation. RESULTS: Good functional outcomes, measured by independent feeding, speech and swallowing were achieved in 35, 36 and 35 patients, respectively. The cumulative 4-year survival rates were 63.8% for tongue cancer and 42.9% for base of tongue cancer. CONCLUSION: Reconstruction with free flaps is a feasible method to restore the functional outcomes in speech and deglutition among patients who undergo total or nearly total glossectomy with laryngeal preservation.     

肩胛舌骨肌上颈淋巴结清扫术治疗cN0N1期口腔鳞癌对术后患者生活质量的影响

目的 探究行肩胛舌骨肌上颈淋巴结清扫术对cN0 N1期口腔鳞癌患者术后生活质量的影响.方法 纳入口腔鳞癌患者112例,依据手术方法不同将行功能性颈淋巴结清扫术(FND)的62例患者纳入FND组,将行肩胛舌骨肌上颈淋巴结清扫术(SOND)的50例患者纳入SOND组.对比2组术后肩关节功能恢复情况、手术前后生活质量评分、术...     

头颈肿瘤放疗后吞咽障碍患者间歇经口管饲的有效性

目的:研究头颈肿瘤放疗后吞咽障碍患者间歇经口管饲的有效性。方法: 选取2015年2月至2019年2月我院收治的80例头颈肿瘤放疗后吞咽障碍患者,根据入院顺序不同分组,各40例。对照组常规留置胃管鼻饲,观察组予以间歇经口管饲,比较两组干预前后营养状态指标［血红蛋白（Hb）、总蛋白（TP）、白蛋白（ALB）、转铁蛋白（TRF）］、吞咽功能变化、注食时和非注食时Kolcaba的舒适状况量表评分、吞咽困难生命质量测量工具评分（SWAL-QOL）、患者尊严量表评分（PDI）、并发症发生率。结果:两组干预前后Hb、TP、ALB、TRF组间比较差异无统计学意义（P>0.05）;观察组优良率（92.50%）较对照组（65.00%）高（P<0.05）;两组注食时Kolcaba的舒适状况量表评分比较差异无统计学意义（P>0.05）;观察组非注食时Kolcaba的舒适状况量表评分高于对照组（P<0.05）;对照组干预后PDI评分较干预前升高（P<0.05）;观察组干预前后PDI评分比较差异无统计学意义（P>0.05）;观察组干预后SWAL-QOL、PDI评分低于对照组（P<0.05）;观察组并发症发生率（2.50%）较对照组（20.00%）低（P<0.05）。结论:头颈肿瘤放疗后吞咽障碍患者采用间歇经口管饲,可保证机体营养供给,促进吞咽功能恢复,保留患者尊严,提高患者舒适度、生存质量,减少并发症的发生。     

Clinicopathologic significance of bcl-2 expression in the surgical treatment of oral tongue carcinoma.

AIM: There is still controversy on the incidence of positive expression of bcl-2 and its prognostic significance for oral tongue carcinoma patients who are treated by surgery. The present study aims at resolving the controversy on the clinicopathologic significance of bcl-2 in a well selected group of patients who satisfy the recruitment criteria: (1) oral tongue carcinoma, (2) squamous cell carcinoma, (3) primary surgical treatment.METHOD: Bcl-2 expression was studied by immunohistochemistry on glossectomy specimens of 73 patients. The expression of bcl-2 was correlated with clinicopathologic data.RESULTS: Of the 73 tumours, 11% had positive expression of bcl-2. Bcl-2 expression was not significantly correlated with tumour grade, stage, nodal metastasis and survival.CONCLUSION: Bcl-2 expression played a minor role in oral tongue carcinoma. It had no significant correlation with tumour grade, stage and nodal metastasis. It also had no prognostic value on survival for patients who were treated by primary surgery.     

改良肩胛舌骨上颈淋巴结清扫术对N0期口腔癌的疗效研究

目的 探讨改良肩胛舌骨上颈淋巴结清扫术(MSOHND)与传统肩胛舌骨上颈淋巴结清扫术(CSOHND)对N0期口腔癌的治疗效果.方法 选取N0期口腔癌患者100例,根据手术方法不同将患者分为MSOHND组(n=55)和CSOHND组(n=45),比较两组患者的手术一般情况、肩关节功能恢复情况及生活质量,分析两组患者术后1年生存率和转移率的差异.结果 两组患者的手术时间、术中出血量比较,差异无统计学意义(P>0.05);MSOHND组患者术后1个月和术后3个月时的肩部疼痛得分明显低于CSOHND组(P<0.001),外展角度明显大于CSOHND组(P<0.001);手术前,两组患者的生活质量比较,差异无统计学意义(P>0.05);手术后,MSOHND组患者术后面容外形、活动能力、消遣娱乐等生活质量得分均较CSOHND组高(P<0.05);两组患者术后1年生存率、转移率比较,差异均无统计学意义(P>0.05).结论 MSOHND对N0期口腔癌具有较好的治疗效果,可明显改善患者术后肩关节功能,提高患者术后生活质量.     

Microvessel density,mast cell density and thymidine phosphorylase expression in oral squamous carcinoma

To elucidate the role of angiogenesis in the carcinogenesis and progression of oral cancer, we investigated microvessel density (mVd), mast cell density (mCd) and thymidine phosphorylase (TP) expression in a series of 50 patients with T1-3 N0-1 M0 oral squamous carcinoma (OSC) and 21 patients with non-dysplastic oral leukoplakia (NDOLP). Paraffin-embedded pathological tissue was utilised for the immunohistochemical analysis of mVd and TP expression. Toluidine blue histochemical method was employed for mast cell identification. OSC and NDOLP were not significantly different with respect to mVd (mVd mean value +/- SD: 30+/-17 and 27+/-18, respectively) and mCd characteristics (mCd mean value +/- SD: 8+/-6 and 7+/-6 units, respectively). Conversely, tumour epithelia showed some degree of TP immunostaining in 100% of cases compared with 76% in NDOLP samples (p< or =0.001 by Fisher's test). A good correlation was found between mVd and mCd in both NDOLP (c.c. 0.632; p=0.002) and OSC (c.c. 0.496; p=0.000) tissue, whereas no association between TP expression and mVd or between mCd and TP status was evident. At a median follow-up of 18 months, patients with high mVd tumours showed a greater probability of survival than those with low mVd (75 and 40%, respectively; p=0.04 log-rank test). Our results suggest that the development of oral cancer epithelia is associated with a significant increase in TP expression. Conversely, the clinical outcome of OSC seems inversely related specifically to mVd.     

Results of surgical treatment of tongue cancer

Fourty-four patients with squamous cell carcinoma of the tongue have been treated by surgery. Twenty-two out of 44 patients were treated by a glossectomy alone and the remaining 22 by en bloc dissection with a glossectomy and neck dissection. The 5-year cumulative survival rate of these 44 cases was 86.1%, broken down as follows: stage I (20 cases), 100%; stage II (9 cases), 88.9%; stage III (11 cases), 72.7%; and, stage IV (4 cases), 50%. Four cases had a recurrence in the primary site, and 6 in the cervical region. Five out of 44 cases died (4 from tongue cancer, and one from other causes). Further, 3 out of 5 cases died of a recurrent cancer in the primary focus or in the neck. Thus, it has been concluded that control of the primary focus and neck metastasis is important for the treatment of tongue cancer, and that surgery also is an excellent therapy for tongue cancer.     

The difference between delayed extubation and tracheostomy in post-operative sleep apnea after glossectomy or laryngectomy

BACKGROUND: Patients with cancer of the tongue or larynx require glossectomies or laryngectomies and subsequent reconstruction. These procedures remove part of the patient's upper airway. In cancer of the tongue, the removed part of the airway is substituted by a flap of their skin. Post-operatively, it is possible that the patients have problems respiring comfortably. In addition to this, long surgical procedures may simply interfere with their circadian rhythm. To elucidate the possible change in their post-operative respiration, we monitored the patient's respiratory pattern with an apnea monitor. METHODS: We attached an apnea monitor to the patients and recorded their respiratory pattern and arterial oxygen saturation. The patients were monitored for a total of five days: three days prior to the operation, one day before the operation, the day of operation, two days after, and on the fourth day after the operation. The period of monitoring was from 8:00 p.m. to 6:00 a.m. the next morning. RESULTS: Sixteen patients completed this study. The patients whose tube was extubated after glossectomy showed frequent apnea, low mean oxygen saturation and low comfort score as compared to the patients with tracheostomy after laryngectomy. Because two failed cases of free skin flap were among the former, it is possible that the frequent apnea is a factor of failed free skin graft after glossectomy and laryngectomy. CONCLUSION: Further studies are required to improve the patient's respiration during their sleep after tracheal extubation in glossectomy.     

Tongue cancer treatment and oncological outcomes: The role of glossectomy classification

BackgroundNowadays surgery remains the gold standard of treatment for tongue cancer. Via a more clear and precise terminology, the glossectomy classification by Ansarin et al. facilitates shared communication between surgeons, allowing comparison between published research and improving surgical practice and patient care. To establish the association of glossectomies, according to their classification by Ansarin et al. with overall survival (OS), disease-free survival (DSF), and cause-specific survival (CSS) in tongue cancer, we conducted a systemic retrospective study on 300 consecutive patients affected by primary oral tongue cancer and treated with surgery at the European Institute of Oncology, IRCCS (IEO).MethodsThree hundred patients with tongue squamous cell carcinoma and treated at the Division of Otorhinolaryngology and Head and Neck Surgery of the European Institute of Oncology, IRCCS were cataloged according to the glossectomy classification. OS, DFS, and CSS were compared by surgical treatments.ResultsOS-5yrs was 80% for the type I glossectomy group, 75% for type II, 65% for type III, and 35% for type IV-V. DFS-5yrs was 74%, 60%, 55%, and 27%, respectively for I, II, III, and IV-V glossectomy group; CSS-5yrs was 82%, 80%, 72%, and 48%, respectively for I, II, III, and IV-V glossectomy group (p < 0.01).ConclusionsThis study confirmed that the application of the glossectomy classification was statistically correlated with patients' oncological outcomes.     

Efficacy and quality-of-life data are related in a phase II trial of oral chemotherapy in previously untreated patients with metastatic colorectal carcinoma.

PURPOSE: To evaluate quality of life (QOL) and tumor response after administration of an oral chemotherapy regimen in patients with previously untreated metastatic colorectal cancer. PATIENTS AND METHODS: Seventy-eight patients received a mean number of 5.8 cycles of therapy. QOL data were analyzed at baseline, after every two cycles of therapy, and at the time of treatment discontinuation. The Uniscale and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 were both utilized. RESULTS: The confirmed response rate was 26% (95% confidence interval [CI], 17% to 37%). Median survival was 11.3 months (95% CI, 9.6 to 15.1 months). Global QOL scores were unchanged over the course of therapy by either tool. Only the physical function subscale score had worsened at the end of therapy. In an analysis of responding patients, significant and durable improvements in both global QOL measures as well as select subscale scores were observed. Diarrhea and physical function QOL scores had declined at the time of treatment discontinuation. Patients who did not respond to therapy had preserved QOL scores when they were evaluated after two cycles of therapy. CONCLUSION: This oral treatment strategy preserved QOL in treated patients. Global QOL measures as well as several QOL subscale scores significantly improved in patients with a documented response to therapy. The profile of improved QOL components indicated that patient well-being was related to tumor response in specific and perceivable ways. Nonresponding patients reported preserved QOL during the first two cycles of therapy. QOL analysis was feasible and informative in this moderately sized multicenter phase II trial.     

Assessment of quality of life and oral function of patients participating in a phase II study of radioprotection of oral and pharyngeal mucosa by the prostaglandin E(1) analog misoprostol (RTOG 96-07)

: The oral complications associated with radiotherapy to the head and neck are a significant dose-limiting factor. The goals of this study were to determine whether oropharyngeal rinsing and ingestion of misoprostol protect mucous membranes from the acute effects of irradiation, and to evaluate the quality-of-life (QOL) outcomes of patients receiving misoprostol. We report the results of the QOL outcomes of patients in this study.

: A total of 33 patients with resected or intact cancer of the oral cavity, oropharynx, supraglottic larynx, or hypopharynx were registered to receive postoperative radiotherapy plus misoprostol or primary radiotherapy plus misoprostol. All patients were scheduled to receive 60–70 Gy at 2 Gy/d within 6–7 weeks. QOL and function were evaluated.

: A decrease in the QOL and function occurred in all areas covered by the questionnaire at the 6-week interval. This decrease was significant for eating, saliva, taste, and mucous. Of these significant factors, taste, saliva, and mucous consistency had not resolved by 12 weeks.

: Increased understanding of the impact of treatment on QOL and symptoms will formulate the rational design of toxicity interventions and enhance the multidisciplinary care of head-and-neck patients.     

Prospective comparison of breast pain in patients participating in a randomized trial of breast-conserving surgery and tamoxifen with or without radiotherapy

PURPOSE: To determine whether breast pain affects quality of life (QOL) after breast-conserving surgery and tamoxifen (TAM) with or without adjuvant breast radiotherapy (RT). METHODS AND MATERIALS: A randomized clinical trial was carried out at the Princess Margaret Hospital between 1992 and 2000 to evaluate the need for breast RT in addition to TAM in women >or=50 years treated with breast-conserving surgery for T1-T2N0 breast cancer. A companion study to assess breast pain was carried out during the last 2 years of the randomized clinical trial. The short-form McGill Pain Questionnaire (SF-MPQ), the European Organization for Research and Treatment of Cancer (EORTC) QOL (QLQ-C30) and EORTC breast cancer module (QLQ-BR23) questionnaires were completed by patients within 1 week of randomization in the randomized clinical trial (baseline) and at 3, 6, and 12 months. RESULTS: Eighty-six patients participated in the breast pain study; 41 received RT plus TAM and 45 received TAM alone. The median age was 70 years (range 51-80). The baseline pain and QOL scores were similar for the two groups. No significant difference was found between the two groups for each scale of the QLQ-C30 and QLQ-BR23 questionnaires at 3, 6, or 12 months (p >0.100), except that at 12 months, the score for role function (QLQ-C30) was higher in the RT plus TAM group than in the RT-only group (p = 0.02). At 3 months, the difference between the mean scores for the SF-MPQ was 0.553 (p = 0.47). At 12 months, the pain scores had decreased in both groups; the difference was 0.199 (p = 0.71). The number of breast operations or surgical complications did not correlate with breast pain in either group. Acute RT toxicity scores did not correlate with breast pain or QOL scores at 12 months. CONCLUSION: These results suggest that breast RT does not significantly contribute to breast pain or adversely impact the QOL up to 12 months after treatment in postmenopausal patients with node-negative breast cancer who take TAM.     

Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life

BACKGROUND.

The risk, severity, and patient‐reported outcomes of radiation‐induced mucositis among head and neck cancer patients were prospectively estimated.

METHODS.

A validated, patient‐reported questionnaire (OMDQ), the FACT quality of life (QOL), and the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scales were used to measure mucositis (reported as mouth and throat soreness), daily functioning, and use of analgesics. Patients were studied before radiotherapy (RT), daily during RT, and for 4 weeks after RT.

RESULTS.

Contrary to previous reports, the risk of mucositis was virtually identical in the 126 patients with oral cavity or oropharynx tumors (99% overall; 85% grade 3‐4) compared with 65 patients with tumors of the larynx or hypopharynx (98% overall; 77% grade 3‐4). The mean QOL score decreased significantly during RT, from 85.1 at baseline to 69.0 at Week 6, corresponding with the peak of mucositis severity. The mean functional status score decreased by 33% from 18.3 at baseline to 12.3 at Week 6. The impact of mucositis on QOL was proportional to its severity, although even a score of 1 or 2 (mild or moderate) was associated with a significant reduction in QOL (from 93.6 at baseline to 74.7 at Week 6). Despite increases in analgesic use from 34% at baseline to 80% at Week 6, mean mucositis scores exceeded 2.5 at Week 6.

CONCLUSIONS.

Mucositis occurs among virtually all patients who are undergoing radiation treatment of head and neck cancers. The detrimental effects on QOL and functional status are significant, and opioid analgesia provides inadequate relief. Preventive rather than symptom palliation measures are needed. Cancer 2008. © 2008 American Cancer Society.     

Quality of life and utility in irradiated laryngeal cancer patients

PURPOSE: To determine quality of life (QOL) and health utility in irradiated laryngeal cancer survivors. MATERIALS AND METHODS: Over 6 months, consecutive follow-up patients at a comprehensive cancer centre completed the QOL questionnaire FACT-H&N and the time trade-off (TTO) utility instrument. RESULTS: Inclusion criteria were met by 339 patients, of whom 269 were eligible, 245 were approached, and 120 agreed to participate. Most participants were men (83%) who had received radiotherapy (97%) for Stage I disease (53%) of the glottis (75%); 7% had undergone total laryngectomy. Participants differed from nonparticipants only in being younger (mean age, 65 vs. 68 years, p = 0.0049) and having higher performance status (Karnofsky 88 vs. 84, p = 0.0012). The average scores for FACT-H&N and the TTO were 124/144 (SD, 14) and 0.90/1.0 (SD, 0.16) respectively. FACT-H&N score was more highly correlated with Karnofsky score (r = 0.43, p = 0.001) than with the TTO (r = 0.29, p = 0.002). Gender predicted QOL (means: M = 125, F = 118), while natural speech, no relapses, and more time since initial treatment predicted higher utility. CONCLUSION: The QOL of irradiated laryngeal cancer survivors was reasonably high and independent of initial disease variables. The QOL questionnaire correlated more strongly with performance status than with utility, suggesting that QOL and utility measures may be perceived differently by patients.     

Modified visor approach applied to total or subtotal glossectomy and reconstruction: avoidance of lip splitting and mandibulotomy and cutting off mental nerve

A lower lip-splitting incision has traditionally been performed with different types of mandibulotomy approaches for obtaining wide access to total or subtotal glossectomy. However, lip splitting can be associated with unfavorable aesthetic and function results. We describe our new modification of a traditional visor approach without lip splitting, mandibulotomy, and reserve mental nerve to avoid these morbidities and to compare aesthetic, functional, and patient subjective outcomes between the two access procedures. Of the patients undergoing total or subtotal glossectomy and reconstruction with flaps, 99 were grouped according to a surgical access procedure performed (lip split and mandibulotomy [LSM] or modified visor approach [MVA]). Data on surgical morbidity and outcomes were compared. All the tumors were safely removed by means of our modified visor approach through the combined intraoral and transcervical routes with adequate resection margins. There were no troublesome difficulties in reconstruction of the surgical defects with various flaps. Recurrence rates, swallowing, chewing, and speech were similar for both groups. Rates of postoperative fistulae were 9.3 % (LSM) vs 0 % (MVA). There were significant differences between the two groups in the temporomandibular joint (TMJ) signs (p?=?0.000) and for appearance domains (p?=?0.01). Avoiding lip splitting and mandibulotomy reduces patient morbidity and hospital stay and gets excellent aesthetic consequences; reserve mental nerve can avoid lower lip numbness after surgery. In our experience, the lower lip-splitting and mandibulotomy procedure for surgical exposure is unnecessary for both oncologic resection and reconstruction of tongue cancers.     

Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy.

This study was conducted to assess long-term Quality of Life (QOL) in patients treated by radiotherapy with or without chemotherapy for anal carcinomas. Patients with a maximum age of 80 years, and who were alive at least 3 years following completion of treatment with a functioning anal sphincter and without active disease, were selected for this study. Of 52 such patients identified, 41 (79%) were evaluable. There were 35 females and six males with a median age of 71 years (55-80). The median follow-up interval was 116 months (range 37-218). QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer: one for cancer-specific QOL (EORTC QLQ-C30) and one for site-specific QOL (EORTC QLQ-CR38). For the function scales a higher score represents a higher level of functioning (100 being the best score), whereas for the symptom scales a higher score indicates a higher level of symptomatology/problems (0 being the best score). For the QLQ-C30, the functional scale scores ranged from 71 (global quality of life) to 85 (role function) and the symptom scale scores from 6 (nausea-vomiting) to 28 (diarrhoea). For the QLQ-CR38 module the functional scale scores ranged from 13 (sexual functioning) to 74 (body image) and for the symptom scale scores from 5 (weight loss) to 66 (sexual dysfunction in males). None of the functional and symptom scale scores seemed to be better in patients with longer follow-up. In patients treated with sphincter conservation for anal carcinomas, long-term QOL as measured by the EORTC QLQ-C30 and QLQ-CR38 appears to be acceptable, with the exception of diarrhoea and perhaps sexual function. Moreover, the subset of patients who presented with severe complications and/or anal dysfunction showed poorer scores in most scales.     

射频消融治疗原发性肝癌的生命质量对比评价

背景与目的以往对原发性肝癌(hepatocellularcarcinoma,HCC)各种治疗疗效的评价主要从治愈率、生存率和生存时间方面进行,近年来生命质量(qualityoflife,QOL)研究倍受关注,能较全面地反映肝癌患者体能恢复状况和切身感受而被广泛应用于癌症、慢性病的疗效评价。目前对于经皮射频消融(radiofrequencyablation,RFA)、经动脉插管栓塞化疗(transcatheterhepaticarterialchemo-embolization,TACE)治疗意义的评价大多关注局部肿瘤灭活率及患者生存率,而对治疗后患者生命质量的研究尚不多见。本研究从患者整体角度对比评估原发性肝癌经皮射频消融治疗后患者的生命质量。方法采用国内肝癌特异性生命质量量表(QOL-LCV2.0),对80例HCC经RFA治疗后QOL进行评定;并与同期40例经动脉插管栓塞化疗(TACE组)以及TACE RFA(联合组)40例分别进行比较。3组患者在年龄、性别、临床分期等方面分布均衡,无明显差异。结果RFA组的QOL总分中位数(168.6)高于TACE组(146.8),差异有显著性(P=0.025);RFA组和联合组在症状/副作用领域的得分中位数45.5、46.0,分别优于单纯TACE组38.1(P<0.01);RFA组躯体功能领域得分呈略高于TACE组的趋势。患者的年龄、收入、治疗后Child-Pugh分级、治疗后新生/复发率、并发症等方面与患者生命质量相关。TACE组和联合组于治疗后Child-Pugh分级提高的比例分别高于RFA组;TACE组新生/复发的比例明显高于RFA组。RFA组的1年、2年和3年生存率(92.8%、89.3%和76.5%)与联合治疗组(94.1%、87.4%、60.0%)比较无统计学差异,但高于TACE组(74.3%、48.2%、48.2%)。结论RFA治疗肝癌,多数患者可获得较好的疗效,严重的副作用少。TACE与RFA联合治疗与单纯TACE相比,可减少患者肝功能损伤,有利于提高原发性肝癌患者的生命质量。     

全胃切除术与近端胃大部切除术治疗胃底贲门癌的远期疗效对比

目的 探讨不同术式治疗胃底贲门癌的远期疗效.方法 对58例胃底贲门癌患者采用手术治疗,其中全胃切除术29例,近端胃大部切除术29例.分析比较2组患者术后并发症和5年生存率.结果 全胃切除术和近端胃大部切除术患者3年生存率分别为62.07%和44.83%(P>0.05),5年生存率为48.28%和20.69%(P<0.05).近端大部切除组的反流性食管炎发生率为75.86%,高于全胃切除组的34.48%(P<0.05);2组患者的其他并发症发生率无统计学差异.肿瘤>3.0 cm和淋巴结转移患者全胃切除后5年生存率高于近端大部切除组(P<0.05),其他情况2组的生存率比较无差异.结论 对胃底贲门癌患者实施全胃切除术治疗能够有效提高患者的长期生存率,尤其是对于肿瘤>3.0 cm和出现淋巴结转移的患者.     

采用射频消融治疗原发性肝癌前后生命质量变化的前瞻性研究

目的：前瞻性分析肝细胞肝癌（hepatocellular carcinoma，HCC）患者射频消融（Radiofrequency Ablation，RFA）治疗前、后生命质量（quality of life，QOL）动态变化，分析术前自我评价及QOL得分与无瘤生存率的关系。方法：采用国内肝癌特异性生命质量量表（QOL—LCV2．0）对经RFA治疗的31例HCC患者，进行治疗前、后共三个时间QOL问卷调查，并探讨术前自我评价得分及QOL得分与近期无瘤生存率的关系。结果：RFA后QOL总分和躯体功能领域得分均呈上升趋势，于2～3个月时高于治疗前水平。症状和副作用得分在治疗后1个月后增高．并于2—3个月时保持不变.心理领域得分与自我评价得分的变化相似，先上升后于2—3个月时下降，但仍高于治疗前水平。RFA后复发／新生组自评得分先上升，之后明显下降：非复发／新生组得分则上升后平稳至2～3个月。治疗前躯体功能得分〉45、患者自评得分〉70的患者，治疗后1年内无瘤生存率分别高于低得分组（x^2=4-30，P=0．038；x^2=4．34，P=0．037）。结论：RFA治疗后1～3个月内，QOL总分及躯体领域得分呈现上升趋势，但患者自我评价和心理状态在第3个月时下降；治疗前躯体功能得分≤45、自评得分≤70且治疗后自评得分下降的患者警惕有复发／新生的可能。