Preoperative and early postoperative quality of life predict survival in potentially curable patients with esophageal cancer.
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.
van Heijl
Mark
M
Department of Surgery, G4-115, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.i.vanbergehenegouwen@amc.uva.nl
Sprangers
Mirjam A G
MA
de Boer
Angela G E M
AG
Lagarde
Sjoerd M
SM
Reitsma
Hans B
HB
Busch
Olivier R C
OR
Tilanus
Hugo W
HW
van Lanschot
Jan J B
JJ
van Berge Henegouwen
Mark I
MI
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