Phippen N T, Secord A A, Wolf S, Samsa G, Davidson B, Abernethy A P, Cella D, Havrilesky L J, Burger R A, Monk B J, Leath C A
Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
Gynecol Oncol. 2017 Oct;147(1):98-103. doi: 10.1016/j.ygyno.2017.07.121. Epub 2017 Jul 23.
Evaluate association between baseline quality of life (QOL) and changes in QOL measured by FACT-O TOI with progression-free disease (PFS) and overall survival (OS) in advanced epithelial ovarian cancer (EOC).
Patients enrolled in GOG-0218 with completed FACT-O TOI assessments at baseline and at least one follow-up assessment were eligible. Baseline FACT-O TOI scores were sorted by quartiles (Q1-4) and outcomes compared between Q1 and Q2-4 with log-rank statistic and multivariate Cox regression adjusting for age, stage, post-surgical residual disease size, and performance status (PS). Trends in FACT-O TOI scores from baseline to the latest follow-up assessment were evaluated for impact on intragroup (Q1 or Q2-4) outcome by log-rank analysis.
Of 1152 eligible patients, 283 formed Q1 and 869 formed Q2-4. Mean baseline FACT-O TOI scores were 47.5 for Q1 vs. 74.7 for Q2-4 (P<0.001). Q1 compared to Q2-4 had worse median OS (37.5 vs. 45.6months, P=0.001) and worse median PFS (12.5 vs. 13.1months, P=0.096). Q2-4 patients had decreased risks of disease progression (HR 0.974, 95% CI 0.953-0.995, P=0.018), and death (HR 0.963, 95% CI 0.939-0.987, P=0.003) for each five-point increase in baseline FACT-O TOI. Improving versus worsening trends in FACT-O TOI scores were associated with longer median PFS (Q1: 12.7 vs. 8.6months, P=0.001; Q2-4: 16.7 vs. 11.1months, P<0.001) and median OS (Q1: 40.8 vs. 16months, P<0.001; Q2-4: 54.4 vs. 33.6months, P<0.001).
Baseline FACT-O TOI scores were independently prognostic of PFS and OS while improving compared to worsening QOL was associated with significantly better PFS and OS in women with EOC.
评估晚期上皮性卵巢癌（EOC）患者的基线生活质量（QOL）与通过FACT-O TOI量表测得的QOL变化与无进展生存期（PFS）和总生存期（OS）之间的关联。
入组GOG-0218研究且在基线时完成FACT-O TOI评估以及至少一次随访评估的患者符合条件。将基线FACT-O TOI得分按四分位数（Q1-4）进行分类，并使用对数秩统计量以及对年龄、分期、术后残留病灶大小和体能状态（PS）进行校正的多因素Cox回归，比较Q1与Q2-4组的预后。通过对数秩分析评估从基线到最新随访评估期间FACT-O TOI得分的变化趋势对组内（Q1或Q2-4）预后的影响。
在1152例符合条件的患者中，283例属于Q1组，869例属于Q2-4组。Q1组的平均基线FACT-O TOI得分为47.5分，而Q2-4组为74.7分（P<0.001）。与Q2-4组相比，Q1组的中位OS更差（37.5个月对45.6个月，P=0.001），中位PFS也更差（12.5个月对13.1个月，P=0.096）。Q2-4组患者的基线FACT-O TOI得分每增加5分，疾病进展风险降低（HR 0.974，95%CI 0.953-0.995，P=0.018），死亡风险降低（HR 0.963，95%CI 0.939-0.987，P=0.003）。FACT-O TOI得分呈改善趋势与呈恶化趋势相比，与更长的中位PFS相关（Q1组：12.7个月对8.6个月，P=0.001；Q2-4组：16.7个月对11.1个月，P<0.001）以及更长的中位OS相关（Q1组：40.8个月对16个月，P<0.001；Q2-4组：54.4个月对33.6个月，P<0.001）。
基线FACT-O TOI得分可独立预测PFS和OS，而在EOC女性患者中，QOL改善与QOL恶化相比，与显著更好的PFS和OS相关。
