涵盖17种癌症类型的46项临床试验中，基线欧洲癌症研究与治疗组织核心生活质量问卷C30评分对总生存期的预后价值：一项验证性研究
Prognostic value of baseline EORTC QLQ-C30 scores for overall survival across 46 clinical trials covering 17 cancer types: a validation study.
作者信息
Lim Luigi, Machingura Abigirl, Taye Mekdes, Pe Madeline, Coens Corneel, Martinelli Francesca, Alanya Ahu, Antunes Stéphanie, Tu Dongsheng, Basch Ethan, Ringash Jolie, Brandberg Yvonne, Groenvold Mogens, Eggermont Alexander, Cardoso Fatima, Van Meerbeeck Jan, Koller Michael, Van der Graaf Winette T A, Taphoorn Martin J B, Koekkoek Johan A F, Reijneveld Jaap C, Soffietti Riccardo, Velikova Galina, Bottomley Andrew, Flechtner Henning, Musoro Jammbe
机构信息
European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
Formerly European Organisation for Research and Treatment of Cancer (EORTC) HQ, Brussels, Belgium.
出版信息
EClinicalMedicine. 2025 Mar 21;82:103153. doi: 10.1016/j.eclinm.2025.103153. eCollection 2025 Apr.
BACKGROUND
A pooled data analysis by Quinten et al. (2009) found three European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) health-related quality of life (HRQoL) scales to be prognostic for survival: physical functioning, pain and appetite loss. This study aims to replicate these findings in an independent data set comprising a broader cancer population.
METHODS
Data were obtained from 46 clinical trials across three cancer research networks conducted between 1996 and 2013 that assessed HRQoL using the EORTC QLQ-C30. A stratified Cox proportional hazards model was employed to assess the prognostic significance of baseline QLQ-C30 scale scores on overall survival, adjusting for socio-demographic and clinical variables. Stepwise model selection was done at 5% significance level. Model stability and prognostic accuracy were evaluated via bootstrapping and the index respectively.
FINDINGS
Data from 16,210 patients reporting HRQoL at baseline, spanning 17 cancer types, was used. The stratified multivariable model confirmed that better physical functioning (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.93-0.96), lower pain (HR, 1.02; 95% CI, 1.01-1.03), and appetite loss (HR, 1.04; 95% CI, 1.03-1.05) were significantly associated with survival. Additionally, global health status/QoL, dyspnoea, emotional and cognitive functioning were found to be prognostic for survival. This final model, encompassing sociodemographic, clinical, and HRQoL variables, achieved a corrected index of 0.74, marking a 48% enhancement in discriminatory ability. Bootstrap evaluation indicated no major instability issues.
INTERPRETATION
These results support previous findings that baseline physical functioning, pain, and appetite loss scores, along with four other scales from the EORTC QLQ-C30, predict survival in cancer patients.
FUNDING
EORTC Quality of Life Group.
背景
昆滕等人（2009年）进行的一项汇总数据分析发现，欧洲癌症研究与治疗组织生活质量问卷核心30项（EORTC QLQ-C30）中的三个健康相关生活质量（HRQoL）量表对生存具有预后价值：身体功能、疼痛和食欲减退。本研究旨在在一个包含更广泛癌症人群的独立数据集中重现这些发现。
方法
数据来自1996年至2013年间在三个癌症研究网络中开展的46项临床试验，这些试验使用EORTC QLQ-C30评估HRQoL。采用分层Cox比例风险模型评估基线QLQ-C30量表得分对总生存的预后意义，并对社会人口统计学和临床变量进行校正。逐步模型选择在5%的显著性水平下进行。通过自抽样法和 指数分别评估模型稳定性和预后准确性。
结果
使用了来自16210例在基线时报告HRQoL的患者的数据，涵盖17种癌症类型。分层多变量模型证实，更好的身体功能（风险比[HR]，0.94；95%置信区间[CI]，0.93-0.96）、更低的疼痛（HR，1.02；95%CI，1.01-1.03）和食欲减退（HR，1.04；95%CI，1.03-1.05）与生存显著相关。此外，全球健康状况/生活质量、呼吸困难、情绪和认知功能被发现对生存具有预后价值。这个包含社会人口统计学、临床和HRQoL变量的最终模型，校正 指数为0.74，表明鉴别能力提高了48%。自抽样法评估表明没有重大的不稳定性问题。
解读
这些结果支持了先前的发现，即基线身体功能、疼痛和食欲减退得分以及EORTC QLQ-C30中的其他四个量表可预测癌症患者的生存。
资助
EORTC生活质量小组。
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