上泌尿道及腎臟腫瘤病人術後生活品質之影響因子:初步分析報告
張雲筑1、邱文靜1、黃鳳珠1、林子平1,3,4、張延驊1,3,4、鍾孝仁1,3,4、
黃逸修1,3,4、林志杰1,3,4、黃奕燊1,3,4、周元華2、林登龍1,3,4、陳光國1,3,4
台北榮民總醫院泌尿部1,台北榮民總醫院精神部2,
國立陽明大學 醫學院 泌尿學科3 ; 書田泌尿科學研究中心4
Factors affect quality of life in patients with renal and upper urinary tract carcinoma after surgery in Taiwan: a preliminary report
Yun-Chu Chang1、Wen-Chin Chiu1、Feng-Chu Huang1、Tzu-Ping Lin1,3,4、Yen-Hwa Chang1,3,4、
Hsiao-Jen Chung1,3,4、Eric YH Huang1,3,4、Chi-Cheh Lin1,3,4、I-shen Huang1,3,4、Yuan-Hwa Chou2、
Alex T. L. Lin1,3,4、 Kuang-Kuo Chen1,3,4
1 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan,
2Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,
3 School of Medicine, National Yang-Ming University, Taipei, Taiwan;
4Shu-Tien Urological Research Center, Taipei, Taiwan
Purpose:
The fluctuation of psychological status in newly diagnosed renal cell and upper tract urothelial carcinoma patients who received operation in Taiwan lacks investigation. This study aims to explore the associations of post-operative 3 months oncological outcome with depressive and anxiety symptoms, and quality of life.
Materials and methods:
We prospectively recruited newly diagnosed renal tumor and upper tract urothelial carcinoma patients who received curative operation between November 2014 and May 2016. Informed consent was obtained from all participants. The personal medical history, peri-operative data and oncological outcome till post-operative 3 months were collected. All patients completed pre-operative and post-operative 3 months Beck Anxiety Inventory, Beck Depression Inventory-II and EORTC QLQ-C30 (version 3) Chinese version. The questionnaires were completed before informing the oncological outcome at post-op 3 months. Patient’s demographic data, pre-operative and post-operative psychological variance with different oncological outcome were analyzed with paired T-test. The overall psychological behavior at pre-operative and post-operative stage were analyzed with Levene's test and Paired-Samples T-test. The relationship between recurrence at post-operative 3 months and psychological behavior were analysed with logistic regression.
Results:
53 renal tumor and 26 upper tract urothelial carcinoma patients were recruited. 42 patients were male( 53.2% ). At the post-op 3 months, there was 11.2% drop-out rate. The mean age at surgery was 61.2 ± 15.0 years and average BMI was 24.9 ± 4.2 kg/m2. The operative methods were classified into open( 46.8% ), laparoscopic( 22.8% ) or robotic-assisted laparoscopic approach( 30.3% ). Benign lesion were proved in 14 (15.7%) patients. Among the malignant cancer patients, 38 patients was diagnosed as early stage disease ( stage I-II, 58.1% ). In pre-operative psychological behavior, significant life quality disturbance in role functioning ( p<0.01 ), diarrhea( p<0.01 ) and financial problem( p<0.01 ) was noted in non-recurrence group. The difference subsided during 3 moths follow-up. (Table 1) But while we compared the average pre-operative and post-operative 3 months psychological behavior, significant improvement was noted in depression ( p<0.01 ), anxiety ( p<0.01 ) and most items of quality of life ( only except dyspnea and financial problem ). The same significant improvement were also found in the subdivided recurrence group while the subdivided non-recurrence group showed better condition only in depression domain( p=0.04 ). (Table 2). In the recurrence group, 2 patients (28.6%) were proved to be benign tumor. EORTC role functioning domain had the strongest relationship with recurrence ( p=0.02 ) in logistic regression
Conclusion:
The improved psychological condition including self reported life-quality was noted in the subgroup analysis of post-operative 3 months recurrence group of renal tumor and upper tract urothelial carcinoma patients, but they were blind to the oncological outcome. Role functioning had the strongest relationship with tumor recurrence.