title: Role functioning is associated with survival in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL. Our study's aim was to evaluate the association of QOL with survival among a cohort of cirrhotic patients with HCC that was diverse with respect to liver function and tumor stage.
  
  
  METHODS
  We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30 and QLQ-HCC18, prior to the treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan-Meier analysis and compared using log rank test to determine whether QOL is associated with survival.
  
  
  RESULTS
  A total of 130 treatment-naïve patients completed both surveys. Patients reported high cognitive and social function (median scores 67) but poor global QOL (median score 50) and poor role function (median score 50). QOL was associated with cirrhosis-related (p = 0.02) and tumor-related (p = 0.02) components of Barcelona Clinic Liver Cancer (BCLC) tumor stage. QOL was associated with survival on univariate analysis (HR 0.37, 95 % CI 0.16-0.85) but became nonsignificant (HR 0.82, 95 % CI 0.37-1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95 % CI 0.20-0.81), after adjusting for Caucasian race (HR 0.31, 95 % CI 0.16-0.59), BCLC stage (HR 1.51, 95 % CI 0.21-1.89), and treatment (HR 0.57, 95 % CI 0.33-0.97).
  
  
  CONCLUSIONS
  Role function has prognostic significance and is important to assess in patients with HCC.
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Meier
authors.forename: Adam
authors.initials: A
authors.lastname: Yopp
authors.forename: Huram
authors.initials: H
authors.lastname: Mok
authors.forename: Pragathi
authors.initials: P
authors.lastname: Kandunoori
authors.forename: Jasmin
authors.initials: J
authors.lastname: Tiro
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000523:psychology*; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012919:Social Behavior; D015996:Survival Rate