A Comprehensive Analysis of the Association Between the EORTC QLQ-C30 Questionnaire and Cachexia in Patients With Gastric Cancer.

BACKGROUND

Cancer cachexia is associated with poor quality of life (QoL) and reduced survival in patients with cancer. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 is a widely used cancer-specific health-related QoL questionnaire that comprises 15 scales, consisting of five multi-item functional scales, three multi-item symptom scales, six single-item symptom scales and a global health and quality-of-life scale. Our study aimed to analyse the association of each scale in the EORTC QLQ-C30 questionnaire with cachexia and explore its influence on survival outcomes in patients with gastric cancer and cachexia.

METHODS

This multicentre cohort study enrolled 3158 patients with gastric cancer, among whom 1711 were diagnosed with cachexia. Logistic regression analysis was conducted to identify the individual scales of the EORTC QLQ-C30 questionnaire significantly affected by cachexia. The Cox model was employed to evaluate the prognostic performance of EORTC QLQ-C30 questionnaire scales in patients with gastric cancer and cachexia.

RESULTS

In this study, the median age of patients with gastric cancer was 67.00 (interquartile range [IQR], 58.00-74.00) years, with 2178 (69.0%) men and 980 (31.0%) women. In logistic regression analyses, scales such as physical function (p < 0.001), global quality of life (p = 0.022), fatigue (p < 0.001), nausea and vomiting (p < 0.001), dyspnoea (p = 0.004), insomnia (p = 0.007), loss of appetite (p < 0.001), constipation (p < 0.001), diarrhoea (p = 0.017) and summary score (p = 0.039) were significantly associated with cachexia in patients with gastric cancer. According to the receiver operating characteristics (ROC) curves, loss of appetite was the most significant scale associated with cachexia. Based on multivariate Cox analyses, the scales of physical function (HR = 1.33, 95% CI = 1.00-1.77, p = 0.049), role function (HR = 1.48, 95% CI = 1.15-1.90, p = 0.002), social function (HR = 1.90, 95% CI = 1.40-2.56, p < 0.001), global quality of life (HR = 1.45, 95% CI = 1.05-2.00, p = 0.026), financial impact (HR = 1.53, 95% CI = 1.15-2.03, p = 0.003) and summary score (HR = 1.39, 95% CI = 1.01-1.91, p = 0.042) were independent risk factors for survival in patients with gastric cancer and cachexia. The concordance index (C-index) and area under the curve (AUC) value for survival prediction were the highest for the social function scale.

CONCLUSION

The QoL of gastric cancer patients with cachexia was significantly reduced. Certain scales in the EORTC QLQ-C30 were significantly associated with cachexia, especially the loss of appetite scale, and survival outcomes in patients with gastric cancer, especially social function. Emphasizing these scales can heighten our awareness of the impact of cachexia on QoL and enhance our ability to predict the survival of patients with gastric cancer and cachexia.

TRIAL REGISTRATION

ChiCTR: 1800020329.