影响晚期肺癌化疗患者生活质量的相关因素分析及预测模型构建  

Analysis of factors influencing quality of life and construction of a prediction model for chemotherapy patients with advanced lung cancer

作　　者：冯叶霞 何靓 张嘉 高时娟 崔育花 夏燕燕 赵红艳 汤紫茹 Feng Yexia;He Liang;Zhang Jia;Gao Shijuan;Cui Yuhua;Xia Yanyan;Zhao Hongyan;Tang Ziru(Department of Oncology,The First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital,Nanjing 210029,China;Department of Internal Medicine,The First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院/江苏省人民医院肿瘤科,南京210029 [2]南京医科大学第一附属医院/江苏省人民医院内科,南京210029

出　　处：《保健医学研究与实践》2024年第12期82-88,共7页Health Medicine Research and Practice

基　　金：国家自然科学基金青年项目(82203148);南京医科大学护理研究中心肿瘤分中心开放课题(NYZLKF-1-202109)。

摘　　要：目的分析影响晚期肺癌化疗患者生活质量的相关因素,并构建预测模型,以冀为生活质量不良高危人群筛查及临床管理开拓新思路。方法选取2021年5月—2023年12月南京某医院肿瘤科和呼吸科收治的142例晚期肺癌化疗患者作为研究对象,收集患者临床资料,根据癌症治疗功能评价量表-共性模块(FACT-G)评分分为生活质量良好组(FACT-G≥平均分)与不良组(FACT-G<平均分)。比较2组患者人口学资料、化疗方案、体能状态、恐动症存在情况等一般资料,分析影响晚期肺癌化疗患者生活质量不良的因素,利用列线图构建其生活质量不良的预测模型。结果不良组与良好组患者的医疗支付方式、体能状态及恐动症、癌因性疲乏、睡眠障碍、抑郁表现存在情况比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,医疗支付方式、抑郁表现是晚期肺癌化疗患者生活质量不良的独立影响因素(OR=0.294、6.134,P<0.05),其中医疗支付方式以自费作为参考类别设置哑变量,发现新农合与商业保险均可使患者生活质量不良的风险降低(OR=0.085、0.046,P<0.05)。以上述2项独立影响因素构建晚期肺癌化疗患者生活质量不良的风险列线图预警模型,Bootstrap法重复抽样内部验证显示校准曲线趋近于理想曲线,受试者工作特征(ROC)曲线显示曲线下面积(AUC)为0.701(0.613~0.790)。结论自费医疗及存在抑郁表现的晚期肺癌化疗患者生活质量不良风险更高,基于二者构建的预测模型可辅助临床筛查高危人群,有利于疾病管理。Objective To analyze factors influencing the quality of life(QoL)in chemotherapy patients with advanced lung canc-er and construct a prediction model,aiming to provide new insights for screening high-risk populations with poor QoL and im-proving clinical management.Methods A total of 142 chemotherapy patients with advanced lung cancer admitted to the oncol-ogy and respiratory departments of a hospital in Nanjing from May 2021 to December 2023 were selected as the study partici-pants.Clinical data were collected,based on the Functional Assessment of Cancer Therapy-General(FACT-G)scale,patients were assigned to a good QoL group(FACT-G≥mean score)and a poor QoL group(FACT-G<mean score).Demographic data,chemotherapy regimens,performance status,kinesiophobia,and other general characteristics were compared between the two groups.Factors influencing poor QoL were analyzed,and a nomogram prediction model for poor QoL was constructed.Results Significant differences were observed between the poor and good QoL groups in medical payment method,perform-ance status,kinesiophobia,cancer-related fatigue,sleep disorders,and depressive symptoms(P<0.05).Multivariate logistic regression analysis identified the medical payment method(OR=0.294)and depressive symptoms(OR=6.134)as independ-ent risk factors for poor QoL(P<0.05).When self-payment was used as the reference category for medical payment,the New Rural Cooperative Medical Care System(OR=0.085)and commercial insurance(OR=0.046)in China significantly re-duced the risk of poor QoL(P<0.05).A nomogram prediction model incorporating these two independent factors was devel-oped.Internal validation via Bootstrap resampling showed that the calibration curve closely approximated the ideal curve.The receiver operating characteristic(ROC)curve revealed an area under the curve(AUC)of 0.701(0.613-0.790).Conclusion Patients with self-payment medical coverage and depressive symptoms are at higher risk of poor QoL.The prediction model based on these factors can assist in the clinical screeni

关 键 词：肺癌 晚期 化疗 生活质量 预测模型 自费 抑郁 

分 类 号：R734.2[医药卫生—肿瘤]