Quality of Life Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
Department of Neurology and Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
Cancer. 2018 Aug;124(16):3409-3416. doi: 10.1002/cncr.31556. Epub 2018 Jun 15.
The aims of this study were to externally validate an established association between baseline health-related quality of life (HRQOL) scores and survival and to assess the added prognostic value of HRQOL with respect to demographic and clinical indicators.
Pooled data were analyzed from 17 randomized controlled trials opened by the Canadian Cancer Trials Group between 1991 and 2004; they included survival and baseline HRQOL data from 3606 patients with 8 different cancer sites. The models included sex, age (≤60 vs >60 years), World Health Organization performance status (0 or 1 vs 2-4), distant metastases (no vs yes), and 15 European Organization for Research and Treatment of Cancer (EORTC) Core Quality-of-Life Questionnaire (QLQ-C30) scales. Analyses were conducted with multivariate Cox proportional hazards models and were stratified by cancer site. Harrell's discrimination C-index was used to calculate the predictive accuracy of the model when HRQOL parameters were added to clinical and demographic variables. The added value of adding HRQOL scales to clinical and demographic variables was illustrated with Kaplan-Meier curves.
In the stratified, multivariate model, HRQOL parameters-global health status (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.95-1.00; P < . 0001), dyspnea (HR, 1.04; 95% CI, 1.02-1.06; P < . 0002), and appetite loss (HR, 1.06; 95% CI, 1.04-1.08; P < . 0001)-were independent prognostic factors in addition to the demographic and clinical variables (all P values < .05). Adding these HRQOL variables to the clinical variables resulted in an added relative prognostic value for survival of 5%.
These results confirm previous findings showing that baseline HRQOL scores on the EORTC QLQ-C30 provide prognostic information in addition to information from clinical measures. However, the impact of specific domains may differ across studies. Cancer 2018. © 2018 American Cancer Society.
本研究旨在对外验证健康相关生活质量（HRQOL）基线评分与生存之间的既定关联，并评估 HRQOL 对人口统计学和临床指标的附加预后价值。
分析了加拿大癌症治疗组（Canadian Cancer Trials Group）于 1991 年至 2004 年期间开展的 17 项随机对照试验的汇总数据；这些数据包含了来自 8 种不同癌症部位的 3606 名患者的生存数据和基线 HRQOL 数据。模型纳入了性别、年龄（≤60 岁 vs >60 岁）、世界卫生组织表现状态（0 或 1 vs 2-4）、远处转移（无 vs 有）和欧洲癌症研究与治疗组织（EORTC）核心问卷（QLQ-C30）的 15 个量表。采用多变量 Cox 比例风险模型进行分析，并按癌症部位进行分层。采用 Harrell 判别 C 指数来计算在加入 HRQOL 参数后，该模型对临床和人口统计学变量的预测准确性。通过 Kaplan-Meier 曲线来说明将 HRQOL 量表加入临床和人口统计学变量的附加价值。
在分层的多变量模型中，HRQOL 参数（总体健康状况，HR 0.97；95%置信区间，0.95-1.00；P<0.0001）、呼吸困难（HR 1.04；95%置信区间，1.02-1.06；P<0.0002）和食欲丧失（HR 1.06；95%置信区间，1.04-1.08；P<0.0001）是除人口统计学和临床变量之外的独立预后因素（所有 P 值均<0.05）。将这些 HRQOL 变量加入临床变量中，生存的相对预后价值增加了 5%。
这些结果证实了之前的研究结果，即 EORTC QLQ-C30 的基线 HRQOL 评分提供了除临床指标之外的预后信息。然而，特定领域的影响可能因研究而异。癌症 2018. © 2018 美国癌症协会。
