Brief Article
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World J Gastroenterol. Jun 7, 2012; 18(21): 2689-2694
Published online Jun 7, 2012. doi: 10.3748/wjg.v18.i21.2689
Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma
Cui-Xia Qiao, Xiao-Feng Zhai, Chang-Quan Ling, Qing-Bo Lang, Hui-Juan Dong, Qun Liu, Mou-Duo Li
Cui-Xia Qiao, Xiao-Feng Zhai, Chang-Quan Ling, Qing-Bo Lang, Hui-Juan Dong, Qun Liu, Mou-Duo Li, Department of Traditional Chinese Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China
Cui-Xia Qiao, Department of Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Chang-Quan Ling, E-Institute of Traditional Chinese Medicine Internal Medicine, Shanghai 200433, China
Author contributions: Qiao CX, Zhai XF, Ling CQ, Lang QB, Dong HJ, Liu Q and Li MD designed the study, collected and analyzed data and wrote the paper; Zhang XF has full access to all the data; and all the authors approved the final version of the paper.
Supported by Grants from the E-Institute of Shanghai Municipal Education Commission, No. E03008; and Shanghai Municipal Health Bureau of Traditional Chinese Medicine Research Project Fund 2010-2011, No. 2010L052B
Correspondence to: Xiao-Feng Zhai, Attending Doctor, Department of Traditional Chinese Medicine, Changhai Hospital Affiliated to the Second Military Medical University, 168 Changhai Road, Shanghai 200433, China. zhaixiaofeng@sina.com
Telephone: +86-21-81873537 Fax: +86-21-81871559
Received: December 7, 2011
Revised: February 6, 2012
Accepted: February 16, 2012
Published online: June 7, 2012
Abstract

AIM: To investigate and evaluate the change in health-related quality of life (HRQoL) by tumor node metastasis (TNM) staging system in patients with hepatocellular carcinoma (HCC).

METHODS: A total of 140 patients diagnosed with HCC between June 2008 and April 2009 in our department were enrolled to this study. One hundred and thirty-five (96.5%) patients had liver cirrhosis secondary to hepatitis B virus (HBV) infection, 73 (54.07%) of them being HBV DNA positive; the other etiologies of liver cirrhosis were alcoholic liver disease (1.4%), hepatitis C (1.4%) or cryptogenic (0.7%). All subjects were fully aware of their diagnosis and provided informed consent. HRQoL was assessed before treatment using the functional assessment of cancer therapy-hepatobiliary (FACT-Hep) questionnaire. Descriptive statistics were used to evaluate demographics and disease-specific characteristics of the patients. One-way analysis of variance and independent samples t tests were used to compare the overall FACT-Hep scores and clinically distinct TNM stages. Scores for all FACT-Hep items were analyzed by frequency analyses. The mean scores obtained from the FACT-Hep in different Child-Pugh classes were also evaluated.

RESULTS: The mean FACT-Hep scores were reduced significantly from TNM Stage I to Stage II, Stage IIIA, Stage IIIB group (687 ± 39.69 vs 547 ± 42.57 vs 387 ± 51.24 vs 177 ± 71.44, P = 0.001). Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage I to Stage IIIB (P = 0.002 vs Stage I; P = 0.032 vs Stage II; P = 0.033 vs Stage IIIA). Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001 vs Stage I; P = 0.036 vs Stage II; P = 0.032 vs Stage IIIA). For the social and family well-being subscale, only Stage IIIB scores were significantly lower as compared with Stage I scores (P = 0.035). For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Stages IIΙ, IIIA and IIIB (P = 0.002 vs Stage I).

CONCLUSION: HRQoL of patients with HCC worsens gradually with progression of TNM stages. The most impaired subscales of HRQoL, as measured by FACT-Hep, were physical and emotional well-being.

Keywords: Hepatocellular carcinoma; Tumor node metastasis staging; Functional assessment of cancer therapy-hepatobiliary; Health-related quality of life; Cross-sectional study