title: Pretreatment quality-of-life score is a better discriminator of oesophageal cancer survival than performance status.
abstract: OBJECTIVE
  Performance status [Eastern Cooperative Oncology Group (ECOG)] is a physician-assigned score indicating a patient's fitness for treatment. Functional assessment of cancer therapy-esophagus (FACT-E) is a patient-reported, health-related quality-of-life (HRQOL) instrument containing an oesophageal cancer subscale (ECS). Our objective was to assess the discriminative ability of pretreatment FACT-E and ECS when compared with performance status in predicting survival in patients with Stage II-III oesophageal cancer.
  
  
  METHODS
  Patient data from four prospective studies were pooled together. These four studies included oesophageal patients who received chemoradiation either as neoadjuvant therapy or as definitive therapy. Three separate Cox regressions were performed considering FACT-E, ECS and ECOG as the main predictors, respectively. Receiver-operating characteristics analyses were performed.
  
  
  RESULTS
  Of the 120 curative intent patients, 39.8% (n = 51), 58.6% (n = 75) and 1.6% (n = 2) had ECOG 0, 1 and 2, respectively. On Cox regression analysis, pretreatment FACT-E (P = 0.04) and ECS (P = 0.004) but not ECOG (P = 0.27) were independently associated with overall survival. ECOG could not discriminate between survivors and non-survivors (P = 0.28) with an area under the curve (AUC) of 0.56 [95% confidence interval (CI): 0.45-0.66], whereas FACT-E (P = 0.02) and ECS (P < 0.001) were discriminative with AUC = 0.63 (95% CI: 0.52-0.73) and AUC = 0.69 (95% CI: 0.60-0.79), respectively.
  
  
  CONCLUSIONS
  In patients with Stage II-III oesophageal cancer being considered for curative therapy, pretreatment FACT-E and ECS have better discrimination for survival than does ECOG. The majority of patients were ECOG 0/1. Thus, these patient-derived scores were able to discriminate survivors from non-survivors even within this constrained range of clinician-assigned performance status. This highlights the potential utility of FACT-E and ECS as prognostic tools.
authors: Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.|Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Biniam
authors: B
authors: Kidane
authors: Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada.|Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
authors: Joanne
authors: J
authors: Sulman
authors: Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
authors: Wei
authors: W
authors: Xu
authors: Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
authors: Qin
authors: Q
authors: Kong
authors: Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
authors: Rebecca
authors: R
authors: Wong
authors: Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
authors: Jennifer J
authors: JJ
authors: Knox
authors: Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada gail.darling@uhn.ca.|Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada.|Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
authors: Gail E
authors: GE
authors: Darling
mesh_terms: D000203:Activities of Daily Living; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods / Q000401:mortality; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012372:ROC Curve; D016896:Treatment Outcome
keywords: Oesophageal cancer; Performance status; Quality of life; Survival