Health-related quality of life parameters as prognostic factors in a nonmetastatic breast cancer population: an international multicenter study.
OBJECTIVE
The purpose of this research was to evaluate whether baseline health-related quality of life (HRQOL) parameters are prognostic factors for survival in locally advanced breast cancer patients. Although the literature highlights the important role of HRQOL parameters in predicting survival in advanced metastatic disease, little evidence exists for earlier stages.


METHODS
The overall sample consisted of 448 patients randomly assigned to receive cyclophosphamide, epirubicin, and fluorouracil versus epirubicin, cyclophosphamide, and granulocyte colony-stimulating factor. Patients were enrolled in 12 countries. HRQOL baseline scores were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. In addition, a bootstrap resampling technique was used to assess the stability of the outcomes. Bootstrap results were then applied for model averaging purposes as a means to account for the observed model selection uncertainty.


RESULTS
The final multivariate model retained inflammatory breast cancer (T4d) as the only factor predicting overall survival (OS) with a hazard ratio of 1.375 (95% CI, 1.027 to 1.840; P =.03). The presence of inflammatory breast cancer lowers the median survival time from 6.6 to 4.2 years (36% reduction). None of the preselected HRQOL variables were prognostic for OS or disease-free survival, in either the univariate or multivariate analysis.


CONCLUSIONS
Our findings suggest that baseline HRQOL parameters have no prognostic value in a nonmetastatic breast cancer population.
European Organisation for Research and Treatment of Cancer, EORTC Data Center, Quality of Life Unit, Ave E Mounier 83, 1200 Brussels, Belgium. fef@eortc.be
Fabio
F
Efficace
Patrick
P
Therasse
Martine J
MJ
Piccart
Corneel
C
Coens
Kristel
K
van Steen
Marzena
M
Welnicka-Jaskiewicz
Tanja
T
Cufer
Jaroslaw
J
Dyczka
Michail
M
Lichinitser
Lois
L
Shepherd
Hanneke
H
de Haes
Mirjam A
MA
Sprangers
Andrew
A
Bottomley
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006304:Health Status; D006801:Humans; D007249:Inflammation; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life
D016179:Granulocyte Colony-Stimulating Factor; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil