Mittal Abhenil, Everest Louis, Patel Devalben, Zhan Luna J, Brown M Catherine, Zaeimi Fatemah, Schmid Sabine, Khan Khaleeq, Dietrich Kristen, Balaratnam Karmugi, de Santayana Miguel Garcia Pardo, Eng Lawson, Sacher Adrian G, Shepherd Frances A, Leighl Natasha B, Cho John, De Perrot Marc, Liu Geoffrey, Bradbury Penelope
Department of Oncology, Northeast Cancer Center, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada.
JTO Clin Res Rep. 2025 Feb 12;6(6):100802. doi: 10.1016/j.jtocrr.2025.100802. eCollection 2025 Jun.
There is a paucity of real-world associations between EQ-5D-generated health utility scores (HUS), symptoms as measured by the Edmonton Symptom Assessment System (ESAS), and the patient-reported outcomes version of the common terminology criteria for adverse events (pro-CTCAE), and survival in patients with advanced Malignant Pleural Mesothelioma (aMPM).
Clinico-demographic variables and treatment information were captured retrospectively in patients diagnosed with aMPM between January 2004 and February 2021 at Princess Margaret Cancer Centre. Quality of life outcomes were measured using HUS, ESAS, and pro-CTCAE scales, by stable versus progressive disease and line-of-treatment states. Survival by mean ESAS scores were analyzed using the Kaplan-Meier method.
Of the 262 patients, the median age was 69 years (interquartile range: 62-74), 77% were male individuals, 52% were ever-smokers, 67% were the epithelioid-subtype, and 62% received first-line systemic therapy for advanced disease. The mean baseline HUS at diagnosis was 0.68 (95% confidence interval: 0.62-0.74) with most symptoms consisting of pain, dyspnea, and fatigue. Pooled ESAS physical and psychological scores changed significantly with disease state: the mean scores were worst at baseline, improved with stable or responding disease (physical, < 0.001; psychological, < 0.001), and worsened at progressive disease (physical: < 0.001; psychological, < 0.001). Similar trends were seen in HUS and pro-CTCAE symptom severity/frequency. Patients with high baseline ESAS physical symptom burden had inferior overall survival (median = 8.9 [high] versus 12.6 months [low], = 0.022). Weak-to-moderate correlations were observed between most ESAS domains and HU and between pro-CTCAE domains and HU. The strongest domain correlations were with well-being, shortness of breath, tiredness, and depression domains.
Baseline quality of life burden is high in patients with aMPM and is well captured by both EQ-5D and ESAS Individual ESAS and pro-CTCAE domains reported low/moderate correlations with HUS, reflecting the inability of one symptom to predict the entire disease state, thus paving the way for future mapping studies. The baseline physical symptom burden (ESAS) was prognostic of survival.
在晚期恶性胸膜间皮瘤（aMPM）患者中，欧洲五维度健康量表（EQ-5D）生成的健康效用分数（HUS）、埃德蒙顿症状评估系统（ESAS）测量的症状、患者报告的不良事件通用术语标准版本（pro-CTCAE）以及生存率之间的真实世界关联较少。
回顾性收集2004年1月至2021年2月在玛格丽特公主癌症中心诊断为aMPM的患者的临床人口统计学变量和治疗信息。使用HUS、ESAS和pro-CTCAE量表，根据疾病稳定与否和治疗线状态测量生活质量结果。采用Kaplan-Meier方法分析平均ESAS评分的生存率。
262例患者中，中位年龄为69岁（四分位间距：62-74岁），77%为男性，52%曾经吸烟，67%为上皮样亚型，62%接受了晚期疾病的一线全身治疗。诊断时的平均基线HUS为0.68（95%置信区间：0.62-0.74），大多数症状包括疼痛、呼吸困难和疲劳。合并的ESAS身体和心理评分随疾病状态显著变化：平均评分在基线时最差，在疾病稳定或缓解时改善（身体，<0.001；心理，<0.001），在疾病进展时恶化（身体：<0.001；心理，<0.001）。HUS和pro-CTCAE症状严重程度/频率也有类似趋势。基线ESAS身体症状负担高的患者总生存期较差（中位生存期=8.9[高]对12.6个月[低]，P=0.022）。在大多数ESAS领域与HUS之间以及pro-CTCAE领域与HUS之间观察到弱至中度相关性。最强的领域相关性是与幸福感、呼吸急促、疲劳和抑郁领域。
aMPM患者的基线生活质量负担较高，EQ-5D和ESAS均能很好地反映这一点。个体ESAS和pro-CTCAE领域与HUS的相关性较低/中等，反映出单一症状无法预测整个疾病状态，从而为未来的映射研究铺平了道路。基线身体症状负担（ESAS）可预测生存率。
