title: The added value of quality of life (QoL) for prognosis of overall survival in patients with palliative hepatocellular carcinoma.
abstract: OBJECTIVE
  Several prognostic classifications (PCs) have been developed for use in palliative care in patients with hepatocellular carcinoma (HCC). We have recently suggested that CLIP combined with WHO PS has the greatest discriminative power. We evaluated the prognostic value of quality of life (QoL) data and whether the latter could improve classification of palliative HCC patients.
  
  
  METHODS
  This was a reanalysis from the CHOC trial with an evaluation of the discriminative power for overall survival (OS) of the established CLIP/GRETCH/BCLC/BoBar prognostic systems alone and then in association with each of the following groups of parameters: selected clinical factors, QoL as continuous variables, dichotomized QoL, selected clinical factors and continuous QoL, selected clinical factors and dichotomized QoL. Baseline QoL was assessed using the EORTC QLQ-C30. Discriminative power was evaluated with the Harrell's C-index and net reclassification improvement.
  
  
  RESULTS
  Quality of life was available in 79% of the patients (n=271). Univariate analysis revealed that better role functioning (HR=0.991 [0.987-0.995]) and better physical functioning (0.991 [0.984-0.997]) scores were associated with longer survival. In contrast, poorer score for fatigue (1.011 [1.006-1.015]) and diarrhoea (1.008 [1.002-1.013]) were associated with shorter survival. After adjustment for clinical and sociodemographic variables, only better role functioning score (0.993 [0.988-0.998]) was associated with longer survival. Adding oedema, hepatomegaly, fatigue and diarrhoea QoL scales to CLIP resulted in the best performance.
  
  
  CONCLUSIONS
  Our results confirm that QoL scales are independent prognostic factors of OS in palliative HCC patients. Incorporation of QoL data improved all the studied PCs.
authors.affiliation: Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France. diouf.momar@chu-amiens.fr
authors.forename: Momar
authors.initials: M
authors.lastname: Diouf
authors.forename: Thomas
authors.initials: T
authors.lastname: Filleron
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Barbare
authors.forename: Loïc
authors.initials: L
authors.lastname: Fin
authors.forename: Carl
authors.initials: C
authors.lastname: Picard
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
authors.forename: Laetitia
authors.initials: L
authors.lastname: Dahan
authors.forename: Xavier
authors.initials: X
authors.lastname: Paoletti
authors.forename: Franck
authors.initials: F
authors.lastname: Bonnetain
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000523:psychology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life