title: Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  Patients with unresectable hepatocellular carcinoma (HCC) have a dismal prognosis. The objective of this study was to evaluate whether patient-reported baseline quality of life (QoL) measured by the EORTC QLQ-C30 instrument is predictive of survival for these patients.
  
  
  METHODS
  Two hundred and thirty-three patients with unresectable HCC (mainly hepatitis B-associated) who were recruited into two separate randomized phase III clinical studies, based on palliative chemotherapy and palliative hormonal therapy, respectively, gave consent and received pretreatment QoL assessment. EORTC QLQ-C30 scores and clinical variables at the time of study entry were analyzed to identify factors that influenced survival by applying multivariate analysis. Independent prognostic factors for survival were studied by Cox regression analysis.
  
  
  RESULTS
  Median survival of the 233 patients was 5.5 months (95% CI 4.2-6.5 months). Significant independent predictors of shorter survival were advanced Okuda staging (P = 0.0030; HR = 2.058), high baseline total bilirubin (P = 0.0008; HR = 1.013) and worse QoL score in the appetite score domain (P = 0.0028; HR for 10 point increase = 1.070). Patients who were entered into the chemotherapy trial (P = 0.0002; HR = 0.503), those who scored better in the physical functioning domain (P = 0.0034; HR for 10 point decrease = 0.911) and the role functioning domain (P = 0.0383; HR for 10 point decrease = 0.944) of the QoL questionnaire, were associated with longer survival.
  
  
  CONCLUSIONS
  In the studied HCC population, patient-reported baseline QoL provides additional prognostic information that supplements traditional clinical factors, and is a new prognostic marker for survival for patients with unresectable HCC.
authors.affiliation: Department of Clinical Oncology and Surgery, Centre for Clinical Trials, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. winnieyeo@cuhk.edu.hk
authors.forename: W
authors.initials: W
authors.lastname: Yeo
authors.forename: F K F
authors.initials: FK
authors.lastname: Mo
authors.forename: J
authors.initials: J
authors.lastname: Koh
authors.forename: A T C
authors.initials: AT
authors.lastname: Chan
authors.forename: T
authors.initials: T
authors.lastname: Leung
authors.forename: P
authors.initials: P
authors.lastname: Hui
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: A
authors.initials: A
authors.lastname: Tang
authors.forename: J J
authors.initials: JJ
authors.lastname: Lee
authors.forename: T S K
authors.initials: TS
authors.lastname: Mok
authors.forename: P B S
authors.initials: PB
authors.lastname: Lai
authors.forename: P J
authors.initials: PJ
authors.lastname: Johnson
authors.forename: B
authors.initials: B
authors.lastname: Zee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D013629:Tamoxifen