Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA.
Cancer Control. 2023 Jan-Dec;30:10732748231185047. doi: 10.1177/10732748231185047.
Previous studies have established that higher baseline quality of life (QOL) scores are associated with improved survival in patients with metastatic colorectal cancer (mCRC). We examined the relationship between overall survival (OS) and baseline QOL.
A total of 1 247 patients with mCRC participating in N9741 (comparing bolus 5-FU/LV, irinotecan [IFL] vs infusional 5-FU/leucovorin [LV]/oxaliplatin [FOLFOX] vs. irinotecan/oxaliplatin [IROX]) provided data at baseline on overall QOL using a single-item linear analogue self-assessment (LASA) 0-100 point scale. The association of OS according to clinically deficient (defined as CD-QOL, score 0-50) vs not clinically deficient (nCD-QOL, score 51-100) baseline QOL scores was tested. A multivariable analysis using Cox proportional hazards modeling was performed to adjust for the effects of multiple baseline factors. An exploratory analysis was performed evaluating OS according to baseline QOL status among patients who did or did not receive second-line therapy.
Baseline QOL was a strong predictor of OS for the whole cohort (CD-QOL vs nCD-QOL: 11.2 months vs 18.4 months, < .0001), and in each arm IFL 12.4 vs 15.1 months, FOLFOX 11.1 months vs 20.6 months, and IROX 8.9 months vs 18.1 months. Baseline QOL was associated with baseline performance status (PS) ( < .0001). After adjusting for PS and treatment arm, baseline QOL was still associated with OS ( = .017).
Baseline QOL is an independent prognostic factor for OS in patients with mCRC. The demonstration that patient-assessed QOL and PS are independent prognostic indicators suggests that these assessments provide important complementary prognostic information.
先前的研究已经证实，转移性结直肠癌（mCRC）患者基线生活质量（QOL）评分较高与生存改善相关。我们研究了总生存期（OS）与基线 QOL 之间的关系。
共 1247 例 mCRC 患者参加了 N9741 试验（比较氟尿嘧啶/亚叶酸钙推注[5-FU/LV]、伊立替康[IFL]与氟尿嘧啶/亚叶酸钙/奥沙利铂[FOLFOX]与伊立替康/奥沙利铂[IROX]），采用单一项目线性模拟自我评估（LASA）0-100 点量表对整体 QOL 进行基线数据采集。根据临床明显缺失（定义为 CD-QOL，评分 0-50）和无临床明显缺失（nCD-QOL，评分 51-100）的基线 QOL 评分，检验 OS 的相关性。采用 Cox 比例风险模型进行多变量分析，以调整多种基线因素的影响。进行了一项探索性分析，根据接受二线治疗和未接受二线治疗的患者的基线 QOL 状态评估 OS。
基线 QOL 是整个队列 OS 的强预测因子（CD-QOL 比 nCD-QOL：11.2 个月比 18.4 个月， <.0001），IFL 组为 12.4 个月比 15.1 个月，FOLFOX 组为 11.1 个月比 20.6 个月，IROX 组为 8.9 个月比 18.1 个月。基线 QOL 与基线体能状态（PS）显著相关（ <.0001）。调整 PS 和治疗臂后，基线 QOL 仍与 OS 相关（ =.017）。
基线 QOL 是 mCRC 患者 OS 的独立预后因素。患者评估的 QOL 和 PS 是独立的预后指标，这表明这些评估提供了重要的互补预后信息。
