title: Preoperative and early postoperative quality of life predict survival in potentially curable patients with esophageal cancer.
abstract: BACKGROUND
  In patients with esophageal cancer, evidence for prognostic significance of preoperative quality of life (QoL) is limited, while the prognostic significance of postoperative QoL has not been investigated at all.
  
  
  OBJECTIVE
  To determine whether preoperative and postoperative QoL measurements can predict survival independently from clinical and pathological factors, in patients with potentially curable esophageal adenocarcinoma.
  
  
  METHODS
  A randomized controlled trial was performed from 1994 to 2000 in two academic medical centres, comparing transthoracic and transhiatal esophagectomy. QoL questionnaires were sent before and 3 months after surgery (Medical Outcome Study Short Form-20 and Rotterdam Symptom Checklist). Uni- and multivariate Cox regression analyses were used to examine firstly the prognostic value of preoperative QoL and several clinical factors, and secondly of postoperative QoL, several clinical factors, and pathological staging.
  
  
  RESULTS
  Out of 220 randomized patients, 199 participated in the QoL-study. In the multivariate preoperative model physical symptom scale (p = 0.021), tumor length (p = 0.034), and endosonographic T-stage (p = 0.003) were predictive for overall survival. In the postoperative multivariate analysis, social functioning (p = 0.035), pain (p = 0.026), and activity level (p = 0.037) predicted survival, besides pathological T-stage (p < 0.001) and N-stage (p < 0.001).
  
  
  CONCLUSIONS
  In the present paper the first large consecutive series of potentially curable esophageal cancer patients is presented in whom prospectively collected QoL data before and after potentially curative surgical resection were used to predict survival. Both preoperative (physical symptoms) and postoperative (social functioning, pain, and activity level) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma.
authors.affiliation: Department of Surgery, G4-115, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amc.uva.nl
authors.forename: Mark
authors.initials: M
authors.lastname: van Heijl
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.forename: Angela G E M
authors.initials: AG
authors.lastname: de Boer
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Hans B
authors.initials: HB
authors.lastname: Reitsma
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate