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Annals of Oncology Advance Access originally published online on September 12, 2006
Annals of Oncology 2006 17(11):1698-1704; doi:10.1093/annonc/mdl183
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© 2006 European Society for Medical Oncology

quality of life and supportive care

Is a patient's self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975

F Efficace1,*, A Bottomley1, EF Smit2, P Lianes3, C Legrand1, C Debruyne1, F Schramel4, HJ Smit5, R Gaafar6, B Biesma7, C Manegold8, C Coens1, G Giaccone2, J Van Meerbeeck9 On behalf of the EORTC Lung Cancer Group and Quality of Life Unit

1 European Organisation for Research and Treatment of Cancer (EORTC), EORTC Data Center, Brussels, Belgium
2 Vrije Universiteit Medical Center, Amsterdam, The Netherlands
3 Hospital de Mataro, Spain
4 St. Antonius Hospital, Nieuwegein, The Netherlands
5 Rijnstate Hospital Arnhem, The Netherlands
6 National Cancer Institute, Cairo, Egypt
7 Jeroen Bosch Ziekenhuis's-Hertogenbosch, The Netherlands
8 University Medical Center, Mannheim, Germany
9 University Hospital, Ghent, Belgium

*Correspondence to: Dr F. Efficace, European Organization for Research and Treatment of Cancer (EORTC), Quality of Life Unit, Avenue E. Mounier, 83, 1200 Brussels, Belgium. Tel: +32 2 7741680; Fax: +32 2 7794568; E-mail: f.efficace{at}fondazioneime.org

Background: The aim of this prognostic factor analysis was to investigate if a patient's self-reported health-related quality of life (HRQOL) provided independent prognostic information for survival in non-small cell lung cancer (NSCLC) patients.

Patients and methods: Pretreatment HRQOL was measured in 391 advanced NSCLC patients using the EORTC QLQ-C30 and the EORTC Lung Cancer module (QLQ-LC13). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap validation technique was used to assess the stability of the outcomes.

Results: The final multivariate Cox regression model retained four parameters as independent prognostic factors for survival: male gender with a hazard ratio (HR) = 1.32 (95% CI 1.03–1.69; P = 0.03); performance status (0 to 1 versus 2) with HR = 1.63 (95% CI 1.04–2.54; P = 0.032); patient's self-reported score of pain with HR= 1.11 (95% CI 1.07–1.16; P < 0.001) and dysphagia with HR = 1.12 (95% CI 1.04–1.21; P = 0.003). A 10-point shift worse in the scale measuring pain and dysphagia translated into an 11% and 12% increased in the likelihood of death respectively. A risk group categorization was also developed.

Conclusion: The results suggest that patients' self-reported HRQOL provide independent prognostic information for survival. This finding supports the collection of such data in routine clinical practice.

Key words: lung cancer, prognostic factor, quality of life, survival


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