Creutzfeldt Anna, Suling Anna, Oechsle Karin, Mehnert Anja, Atanackovic Djordje, Kripp Melanie, Arnold Dirk, Stein Alexander, Quidde Julia
Department of Oncology, Hematology, BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hubertus Wald Tumour Center - University Cancer Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
BMC Palliat Care. 2016 Mar 1;15:25. doi: 10.1186/s12904-016-0101-z.
Systemic treatment has proven to improve physical symptoms in patients with advanced cancer. Relationship between quality of life (QoL) or symptom burden (SYB) and treatment efficacy (tumour response and survival) is poorly described. Therefore, we evaluated the predictive value of pretreatment QoL and SYB on treatment outcomes.
Eligible patients had metastatic gastrointestinal cancers and were about to receive 1st/2nd line palliative chemotherapy. 47 patients were consecutively enrolled. QoL and SYB were assessed by EORTC QLQ-C30 and MSKCC MSAS questionnaires before treatment and after first response evaluation after 8-12 weeks. Logistic regression analysis of QoL and SYB for prediction of objective treatment efficacy was performed. Patients were categorized according to response rate (RR) based on RECIST1.1 and progression free survival (PFS). PFS was categorized by a ratio (individual PFS/expected PFS) in above median (ratio ≥ 1) or below median PFS (ratio < 1). QoL and SYB were analysed for RR groups (partial response, stable or progressive disease) and PFS ratio (PFSR).
Objective response to chemotherapy and increase in PFS were associated with better pretreatment QoL and less SYB. Patients with future objective treatment efficacy (PFSR ≥ 1) evidenced clinically relevant better role/emotional/cognitive/social functioning and less fatigue and appetite loss at baseline in comparison to PFSR < 1 (>10 points difference). Lowest scores in all functioning scales at treatment start were seen in patients with future PFSR < 1. Global health status (EORTC), PSYCH subscale and global distress index (MSAS) predicted PFSR, even if adjusted for gender, age, cancer type, ECOG and line of treatment (p < 0.05). Interestingly, improved QoL and SYB (subjective benefit) were noted even in patients with worse pretreatment status and no objective tumour response.
Future non-responders seem to show distinct QoL patterns before chemotherapy. This may facilitate early detection of patients deriving less or even no benefit from treatment regarding prolongation of survival. Even in patients with primarily progressive disease QoL and SYB may improve during treatment. Integration of QoL and SYB assessment into decision-making about palliative chemotherapy seem to be an important approach to improve patient outcome and should be further evaluated.
全身治疗已被证明可改善晚期癌症患者的身体症状。生活质量（QoL）或症状负担（SYB）与治疗效果（肿瘤反应和生存）之间的关系描述甚少。因此，我们评估了治疗前QoL和SYB对治疗结果的预测价值。
符合条件的患者患有转移性胃肠道癌，即将接受一线/二线姑息化疗。连续纳入47例患者。在治疗前以及8-12周后的首次反应评估后，通过欧洲癌症研究与治疗组织生活质量核心问卷（EORTC QLQ-C30）和纪念斯隆凯特琳癌症中心症状评估量表（MSKCC MSAS）问卷评估QoL和SYB。对QoL和SYB进行逻辑回归分析以预测客观治疗效果。根据基于实体瘤疗效评价标准1.1（RECIST1.1）的缓解率（RR）和无进展生存期（PFS）对患者进行分类。PFS按比例（个体PFS/预期PFS）分为高于中位数（比例≥1）或低于中位数PFS（比例<1）。分析RR组（部分缓解、病情稳定或进展性疾病）和PFS比例（PFSR）的QoL和SYB。
化疗的客观反应和PFS的增加与治疗前更好的QoL和更少的SYB相关。与PFSR<1的患者相比（差异>10分），未来具有客观治疗效果（PFSR≥1）的患者在基线时表现出临床上更良好的角色/情感/认知/社交功能，以及更少的疲劳和食欲减退。未来PFSR<1的患者在治疗开始时所有功能量表得分最低。即使在调整了性别、年龄、癌症类型、东部肿瘤协作组（ECOG）状态和治疗线数后，全球健康状况（EORTC）、心理亚量表和全球痛苦指数（MSAS）仍可预测PFSR（p<0.05）。有趣的是，即使在治疗前状态较差且无客观肿瘤反应的患者中，也观察到QoL和SYB有所改善（主观获益）。
未来无反应者在化疗前似乎表现出不同的QoL模式。这可能有助于早期发现那些在延长生存期方面从治疗中获益较少甚至无获益的患者。即使在主要为疾病进展的患者中，QoL和SYB在治疗期间也可能改善。将QoL和SYB评估纳入姑息化疗决策似乎是改善患者预后的重要方法，应进一步评估。
