癌情隐瞒与非小细胞肺癌生存不良的相关性分析

目的：探讨癌情隐瞒与非小细胞肺癌(non-small cell lung carcinoma，NSCLC)患者生存不良的关系。方法： 收集865名NSCLC患者信息，包括年龄、性别、地址、TNM分期和肿瘤知情情况，通过Kaplan-Meier方法和Cox回归分 析计算患者的生存率。通过电话或面对面的方式，对医生、护士、患者及其家属关于患者肿瘤知情或隐瞒的情况及 相关原因进行调查。结果：在平均随访304(0~4 718) d后，肿瘤知情组的394名患者中有62例存活，而471名癌情隐瞒 组中只有26例存活。单因素分析发现癌情隐瞒组肿瘤相关生存率和全死因生存率均明显低于肿瘤知情组(P<0.001)。 Cox多元回归分析表明癌情隐瞒组的肿瘤相关生存率(HR=1.534，95% CI：1.320~1.784，P<0.001)和全死因生存率 (HR=1.558，95% CI：1.346~1.803，P<0.001)显著低于肿瘤知情组。94.57%的患者家属选择癌情隐瞒的主要原因是“避 免心理崩溃”，他们认为肿瘤知情可能加速死亡。结论：癌情隐瞒是NSCLC患者生存不良的危险因素，我国传统文化 中的“讳疾”可能阻止患者获得真正的“生存权”。

Association between cancer concealment and the survival of the patients with non-small cell lung carcinoma

Objective: To explore the relationship between cancer awareness and the survival of the patients with non-small cell lung carcinoma (NSCLC). Methods: A total of 865 NSCLC patients were screened for the risk factors, including age, gender, address, tumor/lymph nodes/metastasis (TNM) stage, and cancer awareness. Survival of the patients was calculated by Kaplan-Meier method and Cox regression analysis. Results: After an average observation time of 304 d (ranging from 0 to 4 718 d), 62 of the 394 patients in the cancer awareness group survived, whereas 26 of the 471 patients in the cancer concealment group survived. Cancer-specific and all-cause survival was poorer in the cancer concealment group (P<0.001 for each, log-rank test). Cox multivariate regression analysis showed that cancer concealment displayed significantly lower cancer-specific survival hazard ratio (HR)=1.534, 95% confi dence interval (CI) 1.320 to 1.784, P<0.001] and all-cause survival (HR=1.558, 95% CI 1.346 to 1.803, P<0.001). Conclusion: Cancer concealment is associated with a poor survival of NSCLC patients, which may prohibit the patients from obtaining the real “right to survival”.