The Prognostic Value of Patient-Reported Outcome Data in Patients With Colorectal Hepatic Metastases Who Underwent Surgery.
BACKGROUND
Patient-reported outcomes (PROs) are critical to evaluate clinically effective treatments and evidence suggests that PROs might predict survival. The prognostic value of PROs in patients with isolated liver metastases from colorectal cancer (CRC) who undergo surgery is unclear. In this study we investigated whether baseline PROs are prognostic in this patient group.


METHODS
From April 2004 to May 2007, consecutive patients who underwent curative resection of CRC liver metastases completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LMC21 questionnaires before surgery. Patients were followed until death or data were censored on April 9, 2012. Cox proportional hazards models were used to assess the effect of PROs on survival controlling for predefined clinical covariates. Models were simplified using a backwards stepwise approach and model utility appraised using the Harrell C and Somers D statistics and bootstrap methods.


RESULTS
Two hundred thirty-two patients underwent liver resection and 101 (43.5%) survived 5 years. Multivariate analysis controlling for relevant clinical covariates showed that a 10-point improvement in baseline global quality of life scores was associated with a 54% improvement in survival (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.33-0.63; P < .001), and a clinically significant weight loss was associated with 75% worse survival (HR, 1.75; 95% CI, 1.20-2.55; P = .004). Smaller effects were noted for worsening abdominal pain, taste problems, and fatigue (30%-38% poorer survival). Results of bootstrap resampling suggested that global health and weight loss most reliably predicted survival.


CONCLUSIONS
Results of this study demonstrated that patients who reported worse baseline global quality of life and increased weight loss before liver resection for CRC liver metastases had significantly poorer survival. These findings if externally validated might be used to inform patients, and could also influence treatment planning and advise follow-up strategies and supportive care.
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. Electronic address: jonathan.rees@bristol.ac.uk.
Jonathan R
JR
Rees
Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom.
Myrddin
M
Rees
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Angus G K
AG
McNair
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Lang'o
L
Odondi
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Chris
C
Metcalfe
Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom.
Timothy
T
John
Department of Hepatobiliary Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, United Kingdom.
Fenella K
FK
Welsh
Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
Jane M
JM
Blazeby
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D015431:Weight Loss
Cancer; Colon; Liver; Patient-reported outcome; Prognosis