老年肝癌手术患者术前衰弱状态和生活质量与预后相关性研究

摘要/Abstract

摘要： 目的：评估老年肝癌手术患者术前衰弱状态并探讨其术后生活质量与预后的关系。
方法：采用回顾性队列研究设计收集四川大学华西医院2022年1月至2023年1月手术治疗的85例老年肝癌患者为研究对象。使用Fried衰弱量表评估患者术前衰弱状态。采用肝癌患者生活质量量表（QOL-LCV2.0）评估患者术后3个月生活质量。采用拟合曲线分析Fried衰弱量表与QOL-LCV2.0评分间关系。采用Kaplan-Meier生存曲线分析衰弱与总体生存率和无复发生存率关系。采用单因素和多因素Cox比例风险回归模型分析患者复发和死亡危险因素。
结果：85例老年肝癌患者中26例（31%）衰弱。衰弱患者年龄、糖尿病比例、饮酒比例、Child-Pugh分级（B级）比例、肿瘤最大直径、肿瘤数目（多发）均高于无衰弱患者,体重指数低于无衰弱患者（均P<0.05）。衰弱患者住院时间、首次下床活动时间和总并发症发生率均高于无衰弱患者（均P<0.05）。术后3个月衰弱患者QOL-LCV2.0得分低于无衰弱患者（P<0.05）。拟合曲线分析显示Fried衰弱量表与QOL-LCV2.0-总分、QOL-LCV2.0-躯体功能、QOL-LCV2.0-心理功能、QOL-LCV2.0-症状不良反应、QOL-LCV2.0-社会支持均呈负相关（均P<0.05）。衰弱患者总生存率和无复发生存率均低于无衰弱患者（均P<0.05）。单因素和多因素Cox比例风险回归模型结果显示,衰弱是老年肝癌手术患者复发和死亡的独立危险因素（均P<0.05）。
结论：老年肝癌患者术前存在较高的衰弱风险,这与术后生活质量下降及预后不良密切相关。

关键词: 老年, 肝癌, 衰弱, 生活质量, 预后

Abstract: Objective:To assess the preoperative frailty status of elderly patients with liver cancer and explore its relationship with postoperative quality of life and prognosis.
Method:A retrospective cohort study was conducted, in which 85 elderly patients with hepatocellular carcinoma who underwent surgical treatment at West China Hospital, Sichuan University between January 2022 and January 2023 were selected as study subjects using the random number table method. The Fried frailty scale was used to assess the preoperative frailty status of patients. The quality of life scale for liver cancer patients (QOL-LCV2.0) was used to assess the patients' quality of life 3 months after surgery. The relationship between the Fried score and the QOL-LCV2.0 score was analysed using a fitted curve. The relationship between frailty and overall survival rate and recurrence-free survival rate was analysed using the Kaplan-Meier survival curve. Univariate and multivariate Cox risk regression analysis was used to analyse the risk factors for recurrence and death in patients.
Results:Of the 85 elderly patients with liver cancer, 26 (31%) were frail. The frail patients had higher age, diabetes, alcohol consumption, Child-Pugh classification (Grade B), maximum tumour diameter, number of tumours (multiple) and lower body mass index than the non-frail patients (all P<0.05). The length of stay, time to first ambulation and total complication rate of frail patients were higher than those of non- frail patients (all P<0.05). Three months after surgery, the QOL-LCV2.0 score of frail patients was lower than that of non- frail patients (P<0.05). Fitting curve analysis showed that the Fried score was negatively correlated with the QOL-LCV2.0 total score, QOL-LCV2.0 somatic function, QOL-LCV2.0 psychological function, QOL-LCV2.0 adverse symptoms, and QOL-LCV2.0 social support (all P<0.05). The overall survival rate and recurrence-free survival rate of frail patients were lower than those of non-frail patients (all P<0.05). Univariate and multivariate Cox risk regression results showed that frailty was an independent risk factor for recurrence and death in patients (all P<0.05).
Conclusion:Elderly patients with liver cancer have a high risk of preoperative frailty, which is closely related to postoperative low quality of life and poor prognosis.

Key words: Elderly, Liver cancer, Frailty, Quality of life, Prognosis

凌元春, 冯金华, 许瑞华, 李争华, 范美龄, 冯缓, 陈芳, 韩蔷, 赵慧杰. 老年肝癌手术患者术前衰弱状态和生活质量与预后相关性研究[J]. 肝癌电子杂志, 2026, 13(3): 77-83.

Ling Yuanchun, Feng Jinhua, Xu Ruihua, Li Zhenghua, Fan Meiling, Feng Huan, Chen Fang, Han Qiang, Zhao Huijie. A study on the correlation of preoperative frailty status with quality of life and prognosis in elderly patients undergoing surgery for hepatocellular carcinoma[J]. Electronic Journal of Liver Tumor, 2026, 13(3): 77-83.

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