title: Self-reported health-related quality of life predicts survival for patients with advanced gastric cancer treated with first-line chemotherapy.
abstract: OBJECTIVE
  To determine whether patients' self-reported quality-of-life (QOL) parameters could predict survival for patients with advanced gastric cancer (AGC) treated with first-line chemotherapy, we performed this analysis based on the data obtained from 254 patients enrolled in three consecutive prospective randomized trials at a single institution.
  
  
  METHODS
  Consenting patients with AGC received first-line chemotherapy as specified in the protocols. QOL was assessed at baseline using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaires. Baseline univariate and multivariate analyses were performed on the QOL data and the recognized clinical predictors for survival.
  
  
  RESULTS
  Of 254 patients, 164 completed the QOL questionnaire at baseline. All patients received fluorouracil-containing first-line chemotherapy for AGC. With 88% observed deaths and a reported median survival of 9.5 months [95% confidence interval (CI) 8.8-10.2 months], there were no significant differences in survival between patients with or without QOL data. The final Cox multivariate model revealed four prognostic factors: age [hazard ratio (HR) 2.08, 95% CI 1.32-3.33, P = 0.002], bone metastasis (HR 2.70, 95% CI 1.30-5.56, P = 0.008), hemoglobin (HR 0.58, 95% CI 0.37-0.92, P = 0.020), and social functioning (HR 0.40, 95% CI 0.23-0.64, P = 0.001). When adjusting for clinical parameters, social functioning was an independently significant prognostic factor for longer survival.
  
  
  CONCLUSIONS
  Baseline social functioning, along with age, presence of bone metastasis, and baseline hemoglobin level, independently predicts survival of AGC patients treated with first-line chemotherapy. QOL assessment should be routinely included to provide useful prognostic information concerning AGC patients.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Moon Sook
authors.initials: MS
authors.lastname: Cho
authors.forename: Young Saing
authors.initials: YS
authors.lastname: Kim
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.forename: Eunmi
authors.initials: E
authors.lastname: Nam
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.forename: Dong Bok
authors.initials: DB
authors.lastname: Shin
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Woon Kee
authors.initials: WK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012649:Self Concept; D012944:Social Support; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000523:psychology; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins