title: Integrating health status and survival data: the palliative effect of lung volume reduction surgery.
abstract: BACKGROUND
  In studies that address health-related quality of life (QoL) and survival, subjects who die are usually censored from QoL assessments. This practice tends to inflate the apparent benefits of interventions with a high risk of mortality. Assessing a composite QoL-death outcome is a potential solution to this problem.
  
  
  OBJECTIVE
  To determine the effect of lung volume reduction surgery (LVRS) on a composite endpoint consisting of the occurrence of death or a clinically meaningful decline in QoL defined as an increase of at least eight points in the St. George's Respiratory Questionnaire total score from the National Emphysema Treatment Trial.
  
  
  METHODS
  In patients with chronic obstructive pulmonary disease and emphysema randomized to receive medical treatment (n = 610) or LVRS (n = 608), we analyzed the survival to the composite endpoint, the hazard functions and constructed prediction models of the slope of QoL decline.
  
  
  RESULTS
  The time to the composite endpoint was longer in the LVRS group (2 years) than the medical treatment group (1 year) (P < 0.0001). It was even longer in the subsets of patients undergoing LVRS without a high risk for perioperative death and with upper-lobe-predominant emphysema. The hazard for the composite event significantly favored the LVRS group, although it was most significant in patients with predominantly upper-lobe emphysema. The beneficial impact of LVRS on QoL decline was most significant during the 2 years after LVRS.
  
  
  CONCLUSIONS
  LVRS has a significant effect on the composite QoL-survival endpoint tested, indicating its meaningful palliative role, particularly in patients with upper-lobe-predominant emphysema.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55902, USA. benzo.roberto@mayo.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Benzo
authors.forename: Max H
authors.initials: MH
authors.lastname: Farrell
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: Robert
authors.initials: R
authors.lastname: Kaplan
authors.forename: John
authors.initials: J
authors.lastname: Reilly
authors.forename: Gerard
authors.initials: G
authors.lastname: Criner
authors.forename: Robert
authors.initials: R
authors.lastname: Wise
authors.forename: Barry
authors.initials: B
authors.lastname: Make
authors.forename: James
authors.initials: J
authors.lastname: Luketich
authors.forename: Alfred P
authors.initials: AP
authors.lastname: Fishman
authors.forename: Frank C
authors.initials: FC
authors.lastname: Sciurba
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology