title: Prognostic values of EORTC QLQ-C30 and QLQ-HCC18 index-scores in patients with hepatocellular carcinoma - clinical application of health-related quality-of-life data.
abstract: Health-related quality-of-life (HRQOL) assessment with EORTC QLQ-C30 was prognostic for overall survival (OS) in patients with advance-stage hepatocellular carcinoma (HCC), but no data existed for early-stage patients. The HCC-specific QLQ-HCC18 has not been evaluated for prognostic value in HCC patients. Utilization of raw HRQOL data in clinical setting has been impractical and non-meaningful. Therefore we developed index scores of QLQ-C30 and QLQ-HCC18 in an attempt to enable clinical utilization of these HRQOL measurements. This study investigates the prognostic significance of QLQ-C30, QLQ-HCC18 and C30/HCC18 index-scores in patients with newly diagnosed HCC which encompasses all stages.
  
  
  
  From 2007-2011, 517 patients were prospectively recruited. HRQOL was assessed at diagnosis using QLQ-C30 and QLQ-HCC18; C30 and HCC18 index-scores were calculated from raw HRQOL data. Cox regression was performed using continuous, dichotomized QLQ-C30 and QLQ-HCC18 variables, or index-scores, together with clinical factors to identify independent factors for OS. Various multivariate models were validated with c-index and bootstrapping for 1000 replications.
  
  
  
  Four hundred and seventy two patients had complete HRQOL data. Their median OS was 8.6 months. In multivariate analysis, independent prognostic HRQOL variables for OS were QLQ-C30 pain (HR 1.346 [1.092-1.661], p = 0.0055), QLQ-C30 physical functioning (HR 0.652 [0.495-0.860], p = 0.0024); QLQ-HCC18 pain (HR 1.382 [1.089-1.754], p = 0.0077) and QLQ-HCC18 fatigue (HR 1.441 [1.132-1.833], p = 0.0030). C30 index-score (HR 2.143 [1.616-2.841], p < 0.0001) and HCC18 index-score (HR 1.957 [1.411-2.715], p < 0.0001) were highly significant factors for OS. The median OS of patients with C30 index-score of 0-20, 21-40, 41-60, 61-100 were 16.4, 7.3, 3.1, 1.8 months respectively (p < 0.0001); while for HCC18 index-score: 16.4, 6.0, 2.8, 1.8 months respectively (p < 0.0001). All the multivariate models were validated, with mean optimism <0.01. The bootstrap validated c-index was 0.78.
  
  
  
  QLQ-C30 and QLQ-HCC18 were prognostic for OS in patients with newly diagnosed HCC irrespective of stage. Both C30 and HCC18 index-scores were highly significant prognostic factors for OS in newly diagnosed HCC patients. Index-scoring provides an effective way to summarize, analyze and interpret raw HRQOL data, and renders QLQ-C30 and QLQ-HCC18 meaningful and communicable in clinical practice. Index-scores could potentially serve as a standardized tool for future HRQOL research.
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Leung
authors.initials: L
authors.lastname: Li
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Frankie Kf
authors.initials: FK
authors.lastname: Mo
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Hui
authors.affiliation: Department of Chemical Pathology, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Nelson Sl
authors.initials: NS
authors.lastname: Tang
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Jane
authors.initials: J
authors.lastname: Koh
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Linda Ks
authors.initials: LK
authors.lastname: Leung
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Annette Ny
authors.initials: AN
authors.lastname: Poon
authors.affiliation: Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Joyce
authors.initials: J
authors.lastname: Hui
authors.affiliation: Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Cheuk M
authors.initials: CM
authors.lastname: Chu
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Kit F
authors.initials: KF
authors.lastname: Lee
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Brigette By
authors.initials: BB
authors.lastname: Ma
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Paul Bs
authors.initials: PB
authors.lastname: Lai
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
authors.forename: Anthony Tc
authors.initials: AT
authors.lastname: Chan
authors.affiliation: Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Simon Ch
authors.initials: SC
authors.lastname: Yu
authors.affiliation: Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR. winnie@clo.cuhk.edu.hk.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000523:psychology; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: Health-related quality-of-life; Hepatocellular carcinoma; Index-score; Liver cancer; Overall survival; Prognosis; QLQ-C30; QLQ-HCC18