问题解决疗法对中晚期肝癌免疫治疗患者抑郁情绪、生活质量及疗效的影响:一项随机对照试验

doi:10.11904/j.issn.1002-3070.2026.01.005

实用肿瘤学杂志 ›› 2026, Vol. 40 ›› Issue (1): 30-40.doi: 10.11904/j.issn.1002-3070.2026.01.005

问题解决疗法对中晚期肝癌免疫治疗患者抑郁情绪、生活质量及疗效的影响:一项随机对照试验

赵凤娟¹, 农小莲², 黄仕环³, 李繁荣², 卢飞臣², 游雪梅^3,4

1.广西医科大学附属肿瘤医院国际医疗部(南宁 530000);
2.广西医科大学附属肿瘤医院肝胆外科;
3.广西医科大学第一附属医院护理部;
4.广西区域性高发肿瘤早期防治研究重点实验室

收稿日期:2025-08-11 修回日期:2025-11-13 出版日期:2026-02-28 发布日期:2026-02-27
通讯作者: 游雪梅,E-mail:youxuemei@stu.gxmu.edu.cn
作者简介:赵凤娟,女,(1985—),博士研究生,副主任护师,从事肿瘤心理相关的研究。
基金资助:
1.广西自然科学基金(编号:2025GXNSFAA069616);2.广西中医药适宜技术开发与推广项目(编号:GZSY2024061)

The effect of problem-solving therapy on depression,quality of life and immunotherapy outcomes in patients with advanced hepatocellular carcinoma:a randomized controlled trial

ZHAO Fengjuan¹, NONG Xiaolian², HUANG Shihuan³, LI Fanrong², LU Feichen², YOU Xuemei^3,4

1. International Medical Department,Guangxi Medical University Cancer Hospital,Nanning 530000,China;
2. Department of Hepatobiliary Surgery,Guangxi Medical University Cancer Hospital;
3. Department of Nursing,The First Affiliated Hospital of Guangxi Medical University;
4. Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor

Received:2025-08-11 Revised:2025-11-13 Online:2026-02-28 Published:2026-02-27

摘要/Abstract

摘要： 目的探讨问题解决疗法(problem-solving therapy,PST)对接受免疫检查点抑制剂(immune checkpoint inhibitor,ICI)治疗的中晚期肝癌患者抑郁情绪及生活质量的干预效果,并分析其对免疫治疗疗效和生存结局的潜在影响,为构建中晚期肝癌患者身心同治的综合治疗模式提供实践依据。方法采用单中心、前瞻性、随机对照设计,纳入在广西医科大学附属肿瘤医院首次接受ICI治疗的中晚期肝癌合并抑郁症状患者,按照1∶1随机分配至对照组(n=53)和试验组(n=53)。主要结局指标为抑郁评分,次要结局指标包括客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)和生活质量评分。对照组在常规治疗的基础上,予以支持性心理干预,试验组在对照组的基础上实施PST。在T0(基线,干预前一天)、T1(干预第4周末)、T2(干预第8周末)、T3(干预结束后第16周末)评估患者抑郁及生活质量,此后每3个月随访患者疗效及生存情况。结果两组患者基线资料比较,差异均无统计学意义(P＞0.05)。两组患者在T1、T2、T3的抑郁评分均低于T0,呈下降趋势,且试验组下降幅度高于对照组,差异有统计学意义(P＜0.05)。两组患者在T1、T2、T3的生活质量得分均高于T0,呈上升趋势,且试验组上升幅度高于对照组,差异有统计学意义(P＜0.05)。随访至2025年11月,试验组患者DCR显著高于对照组(92.45% vs. 71.70%,P=0.005),但ORR差异无统计学意义(33.96% vs. 22.64%,P=0.196)。生存分析结果显示,两组间短期OS(＜12个月)差异有统计学意义(P=0.006),试验组12个月内的总生存率高于对照组;短期PFS(＜6个月)比较差异无统计学意义(P=0.087)。结论 PST可缓解中晚期肝癌患者的抑郁情绪,改善其生活质量,提高部分患者免疫治疗获益和1年生存率,但其潜在机制仍有待进一步研究。

关键词: 肝细胞癌, 问题解决疗法, 抑郁, 免疫治疗, 生活质量, 随机对照试验

Abstract: Objective The aim of this study was to investigate the effects of problem-solving therapy(PST)on depression and quality of life in patients with advanced hepatocellular carcinoma(HCC)undergoing immune checkpoint inhibitor(ICI)therapy,and to analyze its potential effect on the efficacy and survival outcomes of immunotherapy,providing practical evidence for constructing a comprehensive treatment model for patients with advanced HCC that integrated physical and psychological therapies. Methods A single-center,prospective,randomized controlled trial was conducted.Patients with advanced HCC who were undergoing ICI therapy for the first time and had depressive symptoms were enrolled and randomly assigned in a 1∶1 ratio to the control group(n=53)and the experimental group(n=53).The primary outcome measure was depression score,and secondary outcome measures included objective response rate(ORR),disease control rate(DCR),overall survival(OS),progression-free survival(PFS),and quality of life score.On the basis of conventional treatment,the control group received supportive psychological intervention,while the experimental group underwent PST in addition to the control group′s treatment.Depression and quality of life were evaluated at T0(baseline,one day before intervention),T1(end of the 4th week of intervention),T2(end of the 8th week of intervention),and T3(16 weeks after the end of intervention).Subsequently,patients were followed up every three months for the efficacy and survival. Results There were no statistically significant differences in baseline characteristics between the two groups(P＞0.05).Depression scores at T1,T2,and T3 were lower than those at T0 in two groups,showing a downward trend,and the decrease was more pronounced in the experimental group than that in the control group,with statistically significant differences(P＜0.05).Quality of life scores at T1,T2,and T3 were higher than those at T0 in two groups,showing an upward trend,and the increase was more pronounced in the experimental group than that in the control group,with statistically significant differences(P＜0.05).The follow-up until November 2025 showed that the DCR in the experimental group was significantly higher than that in the control group(92.45% vs. 71.70%,P=0.005),but there was no significant difference in ORR(33.96% vs. 22.64%,P=0.196).Survival analysis results indicated a statistically significant difference in short-term OS(＜12 months)between the two groups(P=0.006),with a higher OS within 12-month in the experimental group compared to the control group;However,there was no statistically difference in short-term PFS(＜6 months)between the two groups(P=0.087). Conclusion PST can alleviate depression in patients with advanced liver cancer,improve their quality of life,and enhance the immunotherapy benefits,and 1-year survival rate in some patients,but its underlying mechanism remains to be further investigated.

Key words: hepatocellular carcinoma, problem-solving therapy, depression, immunotherapy, quality of life, randomized controlled trial

中图分类号:

R735.7

赵凤娟, 农小莲, 黄仕环, 李繁荣, 卢飞臣, 游雪梅. 问题解决疗法对中晚期肝癌免疫治疗患者抑郁情绪、生活质量及疗效的影响:一项随机对照试验[J]. 实用肿瘤学杂志, 2026, 40(1): 30-40.

ZHAO Fengjuan, NONG Xiaolian, HUANG Shihuan, LI Fanrong, LU Feichen, YOU Xuemei. The effect of problem-solving therapy on depression,quality of life and immunotherapy outcomes in patients with advanced hepatocellular carcinoma:a randomized controlled trial[J]. Journal of Practical Oncology, 2026, 40(1): 30-40.

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问题解决疗法对中晚期肝癌免疫治疗患者抑郁情绪、生活质量及疗效的影响:一项随机对照试验

The effect of problem-solving therapy on depression,quality of life and immunotherapy outcomes in patients with advanced hepatocellular carcinoma:a randomized controlled trial

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