晚期肝细胞癌化疗患者癌因性疲乏变化轨迹亚型分析

摘要/Abstract

摘要： 目的: 探讨晚期肝细胞癌（HCC）化疗患者癌因性疲乏（CRF）变化轨迹及其影响因素。
方法: 选择皖西卫生职业学院附属医院2021年10月至2023年10月间治疗的95例晚期HCC患者。通过Piper疲乏修订量表（PFS-R）评估患者6次化疗前、化疗后和化疗后1周的CRF特征。采用混合增长模型识别CRF轨迹亚型。采用Kaplan-Meier法分析不同CRF轨迹亚型总生存率。采用多因素logistic回归分析不同CRF轨迹亚型的影响因素。
结果: 共识别出4种CRF轨迹亚型,分别为高疲乏快速增长型15例（15.8%）、高疲乏中速增长型10例（10.5%）、中疲乏缓慢增长型29例（30.5%）和低疲乏缓慢增长型41例（43.2%）。4种CRF轨迹亚型的总生存率均逐渐降低（均P<0.05）。多因素logistic回归分析显示年龄、体质量指数和C反应蛋白是3种CRF增长型的共同影响因素（均P<0.05）;白蛋白是中疲乏缓慢增长型的独立影响因素（P<0.05）;文化程度和居住方式均是高疲乏快速增长型的独立影响因素（均P<0.05）。
结论: 晚期HCC化疗患者CRF呈现4种CRF轨迹亚型,并鉴定出不同CRF轨迹亚型的独立影响因素,为晚期HCC化疗患者CRF的个性化、全程化管理提供临床依据及新思路。

关键词: 晚期肝细胞癌, 癌因性疲乏, 化疗, 轨迹

Abstract: Objective: To investigate the trajectory of cancer-related fatigue (CRF) and its influencing factors in chemotherapy patients with advanced hepatocellular carcinoma (HCC).
Methods: Ninety-five patients with advanced HCC treated between October 2021 and October 2023 in Affiliated Hospital of West Anhui Health Vocational College were selected. Patients' CRF was assessed by Piper fatigue scale-revised (PFS-R) before, after and 1 week after 6 chemotherapy sessions. A mixed growth model was used to identify CRF trajectory subtypes. The Kaplan-Meier method was used to analyze the overall survival of different CRF trajectory subtypes. Multifactorial logistic regression was used to analyze the influencing factors of different CRF trajectory subtypes.
Results: A total of four CRF trajectory subtypes were identified in this study: high fatigue fast-growth type in 15 cases (15.8%), high fatigue moderate-growth type in 10 cases (10.5%), moderate fatigue slow-growth type in 29 cases (30.5%) and low fatigue slow-growth type in 41 cases (43.2%). The overall survival rates of high-fatigue rapid-growth, high-fatigue moderate-growth, moderate-fatigue stable, and low-fatigue slow-growth types increased gradually (all P<0.05). Multifactorial logistic regression analysis showed that age, body mass index and C-reactive protein were the common influencing factors for the three CRF growth types (P<0.05); albumin was a independent influencing factors for the moderate-fatigue slow-growth type (P<0.05); and literacy level and mode of residence were the independent influencing factors for the high-fatigue fast-growth type (all P<0.05).
Conclusion: CRF in advanced HCC chemotherapy patients presented four CRF trajectory subtypes, and the unique influencing factors of different CRF trajectory subtypes were identified, which provided clinical basis and new ideas for the personalized and holistic management of CRF in advanced HCC chemotherapy patients.

Key words: Advanced hepatocellular carcinoma, Cancer-caused fatigue, Chemotherapy, Trajectory

贾义德, 曹志国, 吴德平, 常远华, 项柱. 晚期肝细胞癌化疗患者癌因性疲乏变化轨迹亚型分析[J]. 肝癌电子杂志, 2025, 12(2): 8-13.

Jia Yide, Cao Zhiguo, Wu Deping, Chang Yuanhua, Xiang Zhu. A longitudinal study of the trajectory of change in cancer-related fatigue in patients treated with chemotherapy for advanced hepatocellular carcinoma[J]. Electronic Journal of Liver Tumor, 2025, 12(2): 8-13.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] MANJUNATHA N, GANDURI V, RAJASEKARAN K, et al.Transarterial chemoembolization and unresectable hepatocellular carcinoma: a narrative review[J]. Cureus, 2022, 14(8): e28439.
[3] SHIMOSE S, IWAMOTO H, NIIZEKI T, et al.Efficacy of lenvatinib combined with transcatheter intra-arterial therapies for patients with advanced-stage of hepatocellular carcinoma: a propensity score matching[J]. Int J Mol Sci, 2023, 24(18): 13715.
[4] SUN J, MAO F, LIU C, et al.Combined FOLFOX4 with all-trans retinoic acid versus FOLFOX4 with placebo in treatment of advanced hepatocellular carcinoma with extrahepatic metastasis: a randomized, double-blind comparative study[J]. Signal Transduct Target Ther, 2023, 8(1): 368.
[5] QIN S, BAI Y, LIM H Y, et al.Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia[J]. J Clin Oncol, 2013, 31(28): 3501-3508.
[6] QIN S, KRUGER E, TAN S C, et al.Cost-effectiveness analysis of FOLFOX4 and sorafenib for the treatment of advanced hepatocellular carcinoma in China[J]. Cost Eff Resour Alloc, 2018, 16: 29.
[7] YANG S, CHU S, GAO Y, et al.A narrative review of cancer-related fatigue (CRF) and its possible pathogenesis[J]. Cells, 2019, 8(7): 738.
[8] 朱虹玉,徐珍华,黎茂璐,等. 胃癌病人化疗期间癌因性疲乏轨迹变化及预测因素研究[J]. 护理研究,2023,37(9):1588-1593.
[9] 张蜀芸,张燕萍,蔡春连,等. 基于结构方程模型的肿瘤患者化疗期癌因性疲乏影响因素分析[J]. 中国全科医学,2018, 21(15):1796-1800.
[1] ROILA F, FUMI G, RUGGERI B,et al.Prevalence, characteristics, and treatment of fatigue in oncological cancer patients in Italy: a cross-sectional study of the Italian Network for Supportive Care in Cancer (NICSO)[J]. Support Care Cancer, 2019, 27(3): 1041-1047.
[2] WANG X S, ZHAO F, FISCH M J, et al.Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors[J]. Cancer, 2014, 120(3): 425-432.
[3] THONG M S Y, VAN NOORDEN C J F, STEINDORF K, et al. Cancer-related fatigue: causes and current treatment options[J]. Curr Treat Options Oncol, 2020, 21(2): 17.
[4] INNOMINATO P F, GIACCHETTI S, MOREAU T, et al.Fatigue and weight loss predict survival on circadian chemotherapy for metastatic colorectal cancer[J]. Cancer, 2013, 119(14): 2564-2573.
[5] MO J, DARKE A K, GUTHRIE K A, et al.Association of fatigue and outcomes in advanced cancer: an analysis of four SWOG treatment trials[J]. JCO Oncol Pract, 2021, 17(8): e1246-e1257.
[6] 贺小军,杨振宇,杜锡林,等. FOLFOX4化疗方案联合免疫治疗在中晚期肝癌中的应用价值(附2例报告)[J]. 现代肿瘤医学,2019,27(14):2518-2523.
[7] O'REGAN P, MCCARTHY G, O'REILLY S, et al. Cancer-related fatigue and self-care agency: a multicentre survey of patients receiving chemotherapy[J]. J Clin Nurs, 2019, 28(23-24): 4424-4433.
[8] STONE P, CANDELMI D E, KANDOLA K, et al.Management of fatigue in patients with advanced cancer[J]. Curr Treat Options Oncol, 2023, 24(2): 93-107.
[9] LUSTBERG M B, KUDERER N M, DESAI A, et al.Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship[J]. Nat Rev Clin Oncol, 2023, 20(8): 527-542.
[10] SCHMIDT M E, HERMANN S, ARNDT V, et al.Prevalence and severity of long-term physical, emotional, and cognitive fatigue across 15 different cancer entities[J]. Cancer Med, 2020, 9(21): 8053-8061.
[11] KOLAK A, KAMIŃSKA M, WYSOKIŃSKA E, et al. The problem of fatigue in patients suffering from neoplastic disease[J]. Contemp Oncol (Pozn), 2017, 21(2): 131-135.
[12] MA Y, HE B, JIANG M, et al.Prevalence and risk factors of cancer-related fatigue: a systematic review and Meta-analysis[J]. Int J Nurs Stud, 2020, 111: 103707.
[13] INGLIS J E, KLECKNER A S, LIN P J, et al.Excess body weight and cancer-related fatigue, systemic inflammation, and serum lipids in breast cancer survivors[J]. Nutr Cancer, 2021, 73(9): 1676-1686.
[14] FERREIRA R S, DA SILVA COQUEIRO R, BARBOSA A R, et al. Relationship between BMI and physical performance among older adults[J]. Geriatr Nurs, 2013, 34(6): 465-468.
[15] SUZAN V, KANAT BB, YAVUZER H.Fatigue and primary sarcopenia in geriatric patients[J]. Rev Assoc Med Bras, 2022, 68(11): 1565-1570.
[16] DE RAAF P J, SLEIJFER S, LAMERS C H, et al. Inflammation and fatigue dimensions in advanced cancer patients and cancer survivors: an explorative study[J]. Cancer, 2012, 118(23): 6005-611.
[17] PERTL M M, HEVEY D, BOYLE N T, et al.C-reactive protein predicts fatigue independently of depression in breast cancer patients prior to chemotherapy[J]. Brain Behav Immun, 2013, 34: 108-119.
[18] CHO H J, SEEMAN T E, BOWER J E, et al.Prospective association between C-reactive protein and fatigue in the coronary artery risk development in young adults study[J]. Biol Psychiatry, 2009, 66(9): 871-878.
[19] VERDONK P, HOOFTMAN W E, VAN VELDHOVEN M J, et al. Work-related fatigue: the specific case of highly educated women in the Netherlands[J]. Int Arch Occup Environ Health, 2010, 83(3): 309-321.
[20] FARAMARZI E, MAHDAVI R, MOHAMMAD-ZADEH M,et al.Effect of conjugated linoleic acid supplementation on quality of life in rectal cancer patients undergoing preoperative chemoradiotherapy[J]. Pak J Med Sci, 2017, 33(2): 383-388.
[21] 李栋霜,蒋运兰,楚鑫,等. 中国癌症患者癌因性疲乏影响因素的meta分析[J]. 现代临床医学,2021,47(2):116-119.
[22] POWELL V D, KUMAR N, GALECKI A T, et al.Bad company: loneliness longitudinally predicts the symptom cluster of pain, fatigue, and depression in older adults[J]. J Am Geriatr Soc, 2022, 70(8): 2225-2234.