Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy.
Medical Oncology Unit, "Paolo Giaccone" University Hospital, Palermo, Italy.
Ann Palliat Med. 2021 Apr;10(4):4252-4261. doi: 10.21037/apm-20-2194. Epub 2021 Apr 1.
Health-related quality of life (HRQoL) is not universally assessed in metastatic colorectal cancer (mCRC) patients. We tried to identify patient subgroups for whom HRQoL assessment should be strongly encouraged.
Consecutive mCRC patients who had been deemed candidates for first-line chemotherapy were enrolled in a prospective study (NCT03873064) and asked to complete the HRQoL questionnaire EORTC QLQ-C30. Primary endpoint was the Global Health Status (GHS) of EORTC QLQ-C30. A nomogram was built for prediction of low GHS (i.e., <67%).
Among recruited patients (n=173), a univariable logistic regression analysis (LRA) found that body mass index (BMI <23), age (>65 years) and sex (female) were significantly associated with low GHS. The multivariable LRA confirmed they were independently associated with the outcome (P values of 0.04-0.004). BMI, age and sex were included in a final predictive model (C-statistics, 67%; P=0.001) and used to build a nomogram. A total nomogram score ≥72 was associated with a risk of 28% or higher of having a low GHS. The 28% risk cut-off had a sensitivity of 90% and a specificity of 34% for identifying low GHS. A decision curve analysis revealed that a risk threshold of 28% of the model was associated to an added net benefit of ≥4% when using the nomogram. Low GHS was recorded in 58% vs. 23% of patients with >28% vs. <28% risk according to the nomogram, respectively (odds ratio 3.54, P=0.0004).
High BMI together with young age and male sex were protective against HRQoL deterioration. In centers where HRQoL is not routinely assessed, such an assessment should be at least made for mCRC patients at risk according to the proposed nomogram (i.e., over 65-year-old females with BMI <23).
健康相关生活质量（HRQoL）并非在转移性结直肠癌（mCRC）患者中普遍评估。我们试图确定应强烈鼓励进行 HRQoL 评估的患者亚组。
符合一线化疗条件的连续 mCRC 患者入组前瞻性研究（NCT03873064），并要求其完成 HRQoL 问卷 EORTC QLQ-C30。主要终点为 EORTC QLQ-C30 的总体健康状况（GHS）。为预测低 GHS（即<67%）建立了列线图。
在入组患者（n=173）中，单变量逻辑回归分析（LRA）发现体重指数（BMI<23）、年龄（>65 岁）和性别（女性）与低 GHS 显著相关。多变量 LRA 证实这些因素与结局独立相关（P 值分别为 0.04-0.004）。BMI、年龄和性别被纳入最终预测模型（C 统计量，67%；P=0.001）并用于构建列线图。总列线图评分≥72 与 GHS 较低的风险（28%或更高）相关。28%风险截断值具有 90%的敏感性和 34%的特异性来识别低 GHS。决策曲线分析显示，当使用列线图时，模型风险阈值为 28%与≥4%的附加净获益相关。根据列线图，GHS 较低的患者分别为 58%（风险>28%）和 23%（风险<28%）（比值比 3.54，P=0.0004）。
高 BMI 以及年轻和男性是 HRQoL 恶化的保护因素。在未常规评估 HRQoL 的中心，应根据拟议的列线图（即 BMI<23 的>65 岁女性）至少对高危 mCRC 患者进行评估。
