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Annals of Oncology Advance Access first published online on April 6, 2006
This version published online on May 15, 2006
Annals of Oncology, doi:10.1093/annonc/mdl065
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© 2006 European Society for Medical Oncology
Received November 28, 2005
Revised February 14, 2006
Accepted February 28, 2006

original article

Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma

W. Yeo 1 *, F. K. F. Mo 1, J. Koh 1, A. T. C. Chan 1, T. Leung 1, P. Hui 1, L. Chan 1, A. Tang 1, J. J. Lee 1, T. S. K. Mok 1, P. B. S. Lai 2, P. J. Johnson 3, and B. Zee 4

1 Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
2 Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China; Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
3 Cancer Research UK, Institute for Cancer Studies, University of Birmingham, UK
4 Centre for Clinical Trials, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China

* To whom correspondence should be addressed.
W. Yeo, E-mail: winnieyeo{at}cuhk.edu.hk


  Abstract

Background: Patients with unresectable hepatocellular carcinoma (HCC) have a dismal prognosis. The objective of this study was to evaluate whether patient-reported baseline quality of life (QoL) measured by the EORTC QLQ-C30 instrument is predictive of survival for these patients.

Materials and methods: Two hundred and thirty-three patients with unresectable HCC (mainly hepatitis B-associated) who were recruited into two separate randomized phase III clinical studies, based on palliative chemotherapy and palliative hormonal therapy, respectively, gave consent and received pretreatment QoL assessment. EORTC QLQ-C30 scores and clinical variables at the time of study entry were analyzed to identify factors that influenced survival by applying multivariate analysis. Independent prognostic factors for survival were studied by Cox regression analysis.

Results: Median survival of the 233 patients was 5.5 months (95% CI 4.2-6.5 months). Significant independent predictors of shorter survival were advanced Okuda staging (P = 0.0030; HR = 2.058), high baseline total bilirubin (P = 0.0008; HR = 1.013) and worse QoL score in the appetite score domain (P = 0.0028; HR for 10 point increase = 1.070). Patients who were entered into the chemotherapy trial (P = 0.0002; HR = 0.503), those who scored better in the physical functioning domain (P = 0.0034; HR for 10 point decrease = 0.911) and the role functioning domain (P = 0.0383; HR for 10 point decrease = 0.944) of the QoL questionnaire, were associated with longer survival.

Conclusions: In the studied HCC population, patient-reported baseline QoL provides additional prognostic information that supplements traditional clinical factors, and is a new prognostic marker for survival for patients with unresectable HCC.

Keywords: liver cancer; QoL; prognostic markers.

An amendment has been made to the second paragraph in the section headed ‘multivariate analysis’.


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