Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Hematol Oncol. 2018 Dec;36(5):749-756. doi: 10.1002/hon.2522. Epub 2018 Jun 3.
Our aim was to evaluate whether quality of life (QOL) scores at diagnosis predict survival among patients with aggressive lymphoma. Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE and systematically followed for event-free and overall survival (OS). QOL was measured with the Functional Assessment of Cancer Treatment-General (FACT-G), which measures 4 domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self-Assessment (LASA) measuring overall QOL; and a spiritual WB LASA. From 9/2002 to 12/2009, 701 patients with aggressive lymphoma who completed baseline QOL questionnaires were enrolled. At a median follow-up of 71 months (range 6-128), 316 patients (45%) had an event and 228 patients (33%) died. All baseline QOL measures but emotional WB were significantly associated with OS (all P < 0.04); of which all but LASA spiritual remained significant after adjusting for IPI and NHL subtype. The strongest associations were with total FACT-G (adjusted HR = 0.86, 95% CI: 0.79-0.94, P = 0.00062) and functional WB (adjusted HR = 0.88, 95% CI: 0.83-0.93, P < .0001). QOL LASA was associated with OS (adjusted HR = 0.92, 95% CI: 0.87-0.97, P = 0.0041). Patients with clinically deficient QOL (overall QOL ≤50) had a median OS of 92 months compared with 121 months for patients with QOL >50 (P = 0.0004). In this large sample of patients with aggressive lymphoma, we found that baseline QOL is independently predictive of OS. QOL should be assessed as a prognostic factor in patients with aggressive lymphoma.
我们的目的是评估诊断时的生活质量（QOL）评分是否可以预测侵袭性淋巴瘤患者的生存。在爱荷华大学/梅奥诊所 SPORE 诊断后 9 个月内，前瞻性招募新诊断的淋巴瘤患者，并对其进行无事件生存和总生存（OS）的系统随访。使用癌症治疗功能评估一般量表（FACT-G）测量 QOL，该量表测量 4 个领域：身体、社会/家庭、情感和功能健康（WB）；一个衡量整体 QOL 的单项线性模拟自我评估（LASA）；以及一个精神 WB LASA。从 2002 年 9 月至 2009 年 12 月，共纳入了 701 例完成基线 QOL 问卷的侵袭性淋巴瘤患者。中位随访时间为 71 个月（范围 6-128 个月），316 例（45%）患者发生事件，228 例（33%）患者死亡。所有基线 QOL 测量值，但情感 WB 与 OS 显著相关（所有 P 值均<0.04）；其中所有 LASA 精神状态以外的指标在调整 IPI 和 NHL 亚型后仍然具有显著意义。与总 FACT-G（调整后的 HR=0.86，95%CI：0.79-0.94，P=0.00062）和功能 WB（调整后的 HR=0.88，95%CI：0.83-0.93，P<0.0001）关联最强。QOL LASA 与 OS 相关（调整后的 HR=0.92，95%CI：0.87-0.97，P=0.0041）。临床 QOL 缺陷（整体 QOL ≤50）患者的中位 OS 为 92 个月，而 QOL >50 的患者中位 OS 为 121 个月（P=0.0004）。在这项侵袭性淋巴瘤患者的大型样本中，我们发现基线 QOL 可独立预测 OS。在侵袭性淋巴瘤患者中，QOL 应作为预后因素进行评估。
