研究背景：肝細胞癌 (Hepatocellular Carcinoma, HCC)，又簡稱肝癌，是癌症死亡率全球排名第四的癌症，在臺灣也有著相當高的盛行及死亡率。肝癌除了會造成病理上的不適之外，也可能進一步導致患者身體功能急遽下降，甚至失能而造成生活無法自理或難以獨立應對生活日常所需要面對的挑戰。此外，HCC患者也常伴有認知功能衰退和心理健康問題，可能進一步影響其生活質量和治療結果。過去許多研究已證實較佳的身體功能與認知功能有關，然而HCC患者的身體功能、認知神經功能及健康相關生活品質之關聯性仍有待研究進一步釐清。
研究目的：探討肝癌患者的認知神經功能、身體功能表現、健康相關生活品質以及其他病理、身體活動量之相關性。
研究方法：本研究自國立成功大學醫學院附設醫院招募所有階段的肝細胞癌患者，並記錄其罹患疾病之時間、BCLC/ Child-Pugh分級、治療方法、治療階段等。當實驗參與者熟悉實驗流程且確認參與意願後，實驗參與者將依以下流程進行實驗：填寫中文版EORTC QLQ-C30、EORTC QLQ-HCC18健康相關生活品質問卷、IPAQ簡版問卷、MMSE簡易認知能力評估問卷、認知能力測驗flanker task並以事件相關電位N2、P3成分波加以分析探討。最後將依順序進行左右手握力、SPPB、TUG test、6公尺步態速度等身體功能測驗。而後以JASP統計軟體進行分析。本研究預期HCC患者的旁側抑制作業之行為表現與身體功能表現、健康相關生活品質之間具有顯著相關，且身體功能表現、健康相關生活品質得分與ERP成分波亦有所關聯。
研究結果：本實驗將共計30位實驗參與者納入分析，參與者平均年齡為64.67歲 (SD = 10.33)，年齡分布介於38~86歲實驗。其中參與者男性占比為86%、女性占比為14%。本研究發現SPPB與一致性任務情境之反應時間 (r = -0.514；p = .004)、反應時間標準差 (r = -0.457；p = .01)、不一致性任務情境之正確率 (r = 0.667；p < .001)、反應時間 (r = -0.563；p = .001)、反應時間標準差 (r = -0.548；p = .002)，與旁側干擾之反應時間 (r = -0.405；p = .026) 及標準差 (r = -0.444；p = .014) 達顯著相關。而6公尺步態速度與一致性任務情境之正確率 (r = -0.425；p = .019)、反應時間 (r = 0.595；p <.001)、反應時間標準差 (r = 0.535；p = .002)、不一致性任務情境之正確率 (r = -0.533；p = .002)、反應時間(r = 0.640；p < .001)、反應時間標準差 (r = 0.621； p < .001)，以及旁側干擾反應時間 (r = 0.446；p = .014) 及標準差 (r = 0.489；p = .006) 達顯著相關。在兩種任務情境中，N2潛時 (p = .002)、P3振幅 (p < .001) 及P3潛時 (p = .005) 有顯著情境間差異。此外，本研究進一步將HCC患者的身體功能、行為表現與成分波的旁側干擾情境間差異進行相關性探討，發現N2成分波之旁側干擾效應之振幅 (flanker effect of N2 amplitude) 對於6公尺步態速度與行為表現之旁側干擾效應的中介效果接近顯著 (coefficient = 12.08, 95% CI [-0.33, 30.58])。
研究結論：本研究發現HCC患者的身體功能表現與意志控制這項認知能力有顯著正相關，亦即身體功能越好、認知能力越佳。此外，在ERP成分波的分析中，本研究發現HCC患者的旁側干擾情境間差異主要體現於P3成分波，顯示HCC患者在抑制控制這項認知能力的下降或許是與大腦較為後期的整體神經資源整合有關。本研究亦發現N2成分波之旁側干擾效應之振幅對於6公尺步態速度與行為表現之旁側干擾效應之間的關聯性有中介效果的趨勢，可做為未來研究與進一步探討HCC患者的認知退化腦神經機制方向。

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality, especially in Taiwan, and is associated with impaired physical and cognitive function, affecting quality of life (QoL). This study examined the relationships among cognitive function, physical performance, and health-related QoL in HCC patients.
Purpose: To investigate associations between motor function, cognitive performance, QoL, and neural activity in patients with HCC.
Methods: Thirty HCC patients (mean age = 64.67 years) were recruited. Assessments included QoL questionnaires (EORTC QLQ-C30/HCC18), IPAQ, MMSE, Flanker task with ERP (N2, P3), and physical tests (grip strength, SPPB, TUG, gait speed). Correlation and mediation analyses were conducted.
Results: SPPB scores were significantly associated with Flanker performance, including reaction time and accuracy across conditions (p < .05). Gait speed was similarly correlated with cognitive performance measures. ERP analysis revealed significant task-related differences in N2 latency (p = .002), P3 amplitude (p < .001), and P3 latency (p = .005). Mediation analysis suggested a potential role of N2 amplitude in linking gait speed to behavioral interference effects.
Conclusion: Better physical function in HCC patients was strongly associated with enhanced inhibitory control. ERP findings highlight the P3 component as a neural marker of cognitive decline, while N2 amplitude may mediate motor-cognitive interactions. These results provide insight into the neurocognitive mechanisms underlying functional decline in HCC, supporting integrative approaches to patient care.

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