握力和癌症分期在老年癌症病人的存活分析

Abstract

癌症蟬連台灣十大死因第一位已經長達三十年，存活無疑是病人及其家屬最關心的議題。而近來在許多大型研究發現，握力可以有效預測老年人的死亡率；老年人因為賀爾蒙改變、慢性發炎、生活型態改變及營養等問題造成不同程度的肌肉質量下降，而癌症病人因為營養吸收及藥物副作用等問題更會加重肌肉質量下降的情形，因此老年癌症病人肌肉質量下降的情形必然更為嚴重，進而使肌肉力量快速下降。美國AJCC癌症分期是目前用於癌症病人存活預測最通用的方法，但在老年族群的預測力仍待被證實。故本篇主要探討握力與AJCC癌症分期是否能有效預測老年癌症病人的存活時間，研究中使用自96年8月至98年4月止於台北某醫學中心一般外科普通病房65歲以上老年癌症病人共95人之腫瘤切除手術前、手術後以及術後三個月的握力，並收集其癌症病理分期及存活情形，最後控制年齡、性別、身體質量指數(BMI)、癌症別、共病指數(Charlson Comorbidity index)、使用藥物數量及是否有介入措施作存活分析，結果顯示AJCC癌症分期雖然仍是最強大的存活預後因子(p<0.01)，然而術前握力亦可做為獨立預測存活的因子(p<0.05)，研究結果為每增加一公斤的術前握力可以降低約5%的死亡機率。由於握力是一個簡單、即時且非侵入性的測量數值，建議未來可以將術前握力放入老年癌症病人之術前評估項目，增加臨床人員及病人和家屬一個簡單有效的存活預後指標。

Cancer has been the first leading cause of death for the past 30 years in Taiwan. Survival is one of the most concerned issues for patients and their families. Literature has suggested that handgrip strength might be an important prognostic factor for mortality, especially in the elderly, but clinical data are limited. The purpose of this study was to examine the predictive power of handgrip strength in the elderly cancer population. As part of a trial study evaluating the effect of a nursing intervention on postsurgical functional decline, 95 elderly cancer patients (≧65 years) who were diagnosed with gastric and pancreatic cancer and scheduled for an abdominal surgery were enrolled from August 2007 to April 2009. Their handgrip strengths were taken prospectively at three time points: admission (preoperative baseline), discharge, and three-month after discharge. Whether handgrip strength is a prognostic factor for survival were analyzed using Cox Regression with cancer staging severed as a covariate. The results shown that for every 1 kg increase in preoperative handgrip strength, the all-cause mortality decreased approximately 5% (95% confidence interval 0.90 to 0.99; P<.05). This result was independent of age, gender, cancer staging, cancer types, body mass index, comorbidity, medication taken, and whether an inpatient nursing intervention was received. The findings suggested that while cancer staging remains to be the strongest prognostic factor, the preoperative handgrip strength is an independent prognostic factor for all-cause survival in the elderly cancer patients with diagnoses of gastric and pancreatic cancer. If verified, handgrip strength measure will be a simple, yet effective parameter that is clinically accessible to predict survival so treatment decisions can be well-informed and justified.