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Annals of Oncology Advance Access published online on September 12, 2006
Annals of Oncology, doi:10.1093/annonc/mdl183
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© 2006 European Society for Medical Oncology
Received May 19, 2006
Revised June 26, 2006
Accepted June 27, 2006

original article

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. Efficace 1 *, A. Bottomley 1, E. F. Smit 2, P. Lianes 3, C. Legrand 1, C. Debruyne 1, F. Schramel 4, H. J. Smit 5, R. Gaafar 6, B. Biesma 7, C. Manegold 8, C. Coens 1, G. Giaccone 2, and J. Van Meerbeeck 9, 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

* To whom correspondence should be addressed.
F. Efficace, E-mail: fabio.efficace{at}eortc.be


  Abstract

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.

Keywords: lung cancer; prognostic factor; quality of life; survival.
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