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Quality of life as a prognostic factor of overall survival in patients with advanced hepatocellular carcinoma: results from two French clinical trials

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Abstract

Aim

The aims of our study were to assess quality of life (QoL) as a prognostic factor of overall survival (OS) and to determine whether QoL data improved three prognostic classifications among French patients with advanced hepatocellular carcinoma (HCC).

Results

Among 538 included patients, QoL at baseline was available for 489 patients (90%). Longer median OS was significantly associated with higher Spitzer scores at baseline, ranging from 2.17 months (Spitzer = 3) to 8.93 months (Spitzer = 10). Variables retained in the multivariate Cox model were: jaundice, hepatomegaly, hepatalgia, portal thrombosis, alphafetoprotein, bilirubin, albumin, small HCC, and Spitzer QoL Index (hazard ratio = 0.84 95% CI [0.79–0.90]). According to Harrell’s C-index, QoL was the best prognostic variable to add. CLIP plus the Spitzer QoL Index had the most discriminating value (C = 0.71).

Conclusions

Our results suggest that QoL is an independent prognostic factor for survival in HCC patients with mainly alcoholic cirrhosis. The prognostic value of CLIP score could be improved by adding Spitzer QOL Index scores.

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References

  1. Parkin, D. M., Bray, F., Ferlay, J., & Pisani, P. (2001). Estimating the world cancer burden. GLOBOCAN 2000. International Journal of Cancer, 94, 153–156. doi:10.1002/ijc.1440.

    Google Scholar 

  2. El-Serag, H. B., Davila, J. A., Petersen, N. J., & McGlynn, K. A. (2003). The continuing increase in the incidence of hepatocellular carcinoma in the United States - An update. Annals of Internal Medicine, 139, 817–823.

    PubMed  Google Scholar 

  3. Remontet, L., Esteve, J., Bouvier, A. M., et al. (2003). Cancer incidence and mortality in France over the period 1978–2000. Revue d’Epidemiologie et de Sante Publique, 51, 3–30.

    PubMed  CAS  Google Scholar 

  4. Garcia, S. F., Cella, D., Clauser, S., et al. (2007). Enhancing patient-reported outcomes assessment in cancer clinical trials: The PROMIS initiative. Journal of Clinical Oncology, 25, 5106–5112. doi:10.1200/JCO.2007.12.2341.

    Google Scholar 

  5. Garcia, S. F., Cella, D., Clauser, S., et al. (1995). Editorial. Quality of life and clinical trials. Lancet, 346, 1–2.

    Google Scholar 

  6. Beitz, J., Gnecco, C., & Justice, R. (1996). Quality-of-life end points in cancer clinical trials: The U.S. Food and drug administration perspective. Journal of the National Cancer Institute. Monographs, 20, 7–9.

    PubMed  Google Scholar 

  7. Johnson, J. R., & Temple, R. (1985). Food and drug administration requirements for approval of new anticancer drugs. Cancer Treatment Reports, 69, 1155–1159.

    PubMed  CAS  Google Scholar 

  8. Lipscomb, J., Donaldson, M. S., Arora, N. K., et al. (2004). Cancer outcomes research. Journal of the National Cancer Institute. Monographs, 33, 178–197. doi:10.1093/jncimonographs/lgh039.

    Google Scholar 

  9. Dancey, J., Zee, B., Osoba, D., et al. (1997). Quality of life scores: An independent prognostic variable in a general population of cancer patients receiving chemotherapy. The National Cancer Institute of Canada Clinical trials Group. Quality of Life Research, 6, 151–158. doi:10.1023/A:1026442201191.

  10. Okuda, K., Ohtsuki, T., Obata, H., et al. (1985). Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer, 56, 918–928. 10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E.

  11. The Cancer of Liver Italian Program Investigators. (1998). A new prognostic system for hepatocellular carcinoma: A retrospective study of 435 patients: The Cancer of the Liver Italian Program (CLIP) investigators. Hepatology (Baltimore, Md.), 28, 751–755. doi:10.1002/hep.510280322.

  12. Llovet, J. M., Bru, C., & Bruix, J. (1999). Prognosis of hepatocellular carcinoma: The BCLC staging classification. Seminars in Liver Disease, 19, 329–338.

    Article  PubMed  CAS  Google Scholar 

  13. Chevret, S., Trinchet, J. C., Mathieu, D., et al. (1999). A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. Journal of Hepatology, 31, 133–141. doi:10.1016/S0168-8278(99)80173-1.

  14. Ueno, S., Tanabe, G., Sako, K., et al. (2001). Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of Liver Italian Program. Hepatology (Baltimore, Md.), 34, 529–534. doi:10.1053/jhep.2001.27219.

  15. Dilou, N., Patouillard, B., & Audigier, J. C. (2004). Les classifications de prédiction de survie du carcinome hépatocellulaire. Gastroenterologie Clinique et Biologique, 28, 359–366. doi:10.1016/S0399-8320(04)94936-6.

    Google Scholar 

  16. The Cancer of Liver Italian Program Investigators. (2000). Prospective validation of the CLIP score: A new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology (Baltimore, Md.), 31, 840–845. doi:10.1053/he.2000.5628.

  17. Levy, I., Sherman, M., & The Liver Cancer Study Group of the University of Toronto (2002). Staging of hepatocellular carcinoma: Assessment of the CLIP, Okuda, and Child-Pugh staging systems in a cohort of 257 patients in Toronto. Gut, 50, 881–885. doi:10.1136/gut.50.6.881.

  18. Wildi, S., Pestalozzi, B. C., McCormack, L., & Clavien, P. A. (2004). Critical evaluation of the different staging systems for hepatocellular carcinoma. British Journal of Surgery, 91, 400–408. doi:10.1002/bjs.4554.

    Google Scholar 

  19. Farinati, F., Rinaldi, M., Gianni, S., & Naccarato, R. (2000). How should patients with hepatocellular carcinoma be staged? Validation of a new prognostic system. Cancer, 89, 2266–2273. doi :10.1002/1097-0142(20001201)89:11<2266::AID-CNCR15>3.0.CO;2-0.

  20. Marrero, J. A., Fontana, R. J., Barrat, A., et al. (2005). Prognosis of hepatocellular carcinoma: Comparison of 7 staging systems in an American cohort. Hepatology (Baltimore, Md.), 41, 707–716. doi:10.1002/hep.20636.

    Google Scholar 

  21. Leung, T. W., Tang, A. M., Zee, B., et al. (2002). Construction of the Chinese university prognostic index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the cancer of the liver Italian program staging system: A study based on 926 patients. Cancer, 94, 1760–1769. doi:10.1002/cncr.10384.

  22. Cillo, U., Vitale, A., Grigoletto, F., et al. (2006). Prospective validation of the Barcelona clinic liver cancer staging system. Journal of Hepatology, 44, 723–731. doi:10.1016/j.jhep.2005.12.015.

    Google Scholar 

  23. Barbare, J. C., Bouché, O., Bonnetain, F., et al. (2005). Randomized controlled trial of tamoxifen in advanced hepatocellular carcinoma. Journal of Clinical Oncology, 23, 4338–4346. doi:10.1200/JCO.2005.05.470.

    Google Scholar 

  24. Doffoël, M., Bonnetain, F., Bouché, O., et al. (2008). Multicentre randomised phase III trial comparing tamoxifen alone or with transarterial lipiodol chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402). European Journal of Cancer, 44, 528–538.

    Article  PubMed  CAS  Google Scholar 

  25. Spitzer, W. O., Dobson, A. J., Hall, J., et al. (1981). Measuring the quality of life of cancer patients. A concise QL-Index for use by physician. Journal of Chronic Diseases, 34, 585–597. doi:10.1016/0021-9681(81)90058-8.

    Google Scholar 

  26. Anderson, R. T., Aaronson, N. K., & Wilkin, D. (1993). Critical review of the international assessments of heath-related quality of life. Quality of Life Research, 2, 369–395. doi:10.1007/BF00422215.

  27. Sloan, J. A., Loprinzi, C. L., Kuross, S. A., et al. (1998). Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. Journal of Clinical Oncology, 16, 3662–3673.

    PubMed  CAS  Google Scholar 

  28. Mazzaferro, V., Regalia, E., Doci, R., et al. (1996). Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. New England Journal of Medicine, 334, 693–699.

    Article  PubMed  CAS  Google Scholar 

  29. Harrell, F. E., Lee, K. L., & Mark, D. B. (1996). Tutorial in biostatistics. Multivariable prognostic models issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Statistics in Medicine, 15, 361–387.

    Article  PubMed  Google Scholar 

  30. Ringdal, G. I., Ringdal, K., Kvinnsland, S., et al. (1994). Quality of life of cancer patients with different prognosis. Quality of Life Research, 3, 143–154.

    Article  PubMed  CAS  Google Scholar 

  31. Ringdal, G. I., Gotestam, K. G., Kaasa, S., et al. (1996). Prognostic factors and survival in a heterogeneous sample of cancer patients. British Journal of Cancer, 73, 1594–1599.

    PubMed  CAS  Google Scholar 

  32. Coates, A., Porzsolt, F., & Osoba, D. (1997). Quality of life in oncology practice: Prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. European Journal of Cancer, 33, 1025–1030.

    Article  PubMed  CAS  Google Scholar 

  33. Coates, A., Forbes, J., & Simes, R. J. (1993). Prognostic value of performance status and quality of life scores during chemotherapy for advanced breast cancer. The Australian New Zealand Breast Cancer Trials Group. Journal of Clinical Oncology, 11, 2050–2051.

    PubMed  CAS  Google Scholar 

  34. Kramer, J. A., Curran, D., Piccart, M., et al. (2000). Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. European Journal of Cancer, 36, 1498–1506.

    Article  PubMed  CAS  Google Scholar 

  35. Efficace, F., Biganzoli, L., Piccart, M., et al. (2004). Baseline health-related quality of life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. European Journal of Cancer, 40, 1021–1030.

    Article  PubMed  CAS  Google Scholar 

  36. Langendijk, H., Aaronson, N. K., de Jong, J. M. A., et al. (2000). The prognostic impact of quality of life assessed with the EORTC QLQ-C30 in inoperable non-small cell lung carcinoma treated with radiotherapy. Radiotherapy and Oncology, 55, 19–25.

    Article  PubMed  CAS  Google Scholar 

  37. Montazeri, A., Milroy, R., Hole, D., et al. (2001). Quality of life in lung cancer patients as an important prognostic factor. Lung Cancer, 31, 233–240.

    Article  PubMed  CAS  Google Scholar 

  38. Herndon, J. E., Fleishman, S., Kornblith, A. N., et al. (1999). Is quality of life predictive of the survival of patients with advanced non small cell lung carcinoma? Cancer, 85, 333–340.

    Article  PubMed  Google Scholar 

  39. Dharma-Wardene, M., Au, H. J., Hanson, J., et al. (2004). Baseline FACT-G score is a predictor of survival for advanced lung cancer. Quality of Life Reseach, 13, 1209–1216.

    Article  CAS  Google Scholar 

  40. Blazeby, J. M., Brookes, S. T., & Alderson, D. (2001). The prognostic value of quality of life scores during treatment for oesophageal cancer. Gut, 49, 227–230.

    Article  PubMed  CAS  Google Scholar 

  41. Fang, F. M., Tsai, W. L., Chiu, H., et al. (2004). Quality of life as a survival predictor for esophageal squamous cell carcinoma treated with radiotherapy. International Journal of Radiation, Biology, Physics, 58, 1394–1404.

    Article  Google Scholar 

  42. Chau, I., Norman, A. R., Cunningham, D., et al. (2004). Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer-pooled analysis from three multicenter, randomized, controlled trails using individual patients data. Journal of Clinical Oncology, 22, 2395–2403.

    Article  PubMed  Google Scholar 

  43. de Graeff, A., de Leeuw, J. R. J., Ros, W. J. G., et al. (2001). Sociodemographic factors and quality of life as prognostic indicators in head and neck cancer. European Journal of Cancer, 37, 332–339.

    Article  PubMed  CAS  Google Scholar 

  44. Ramsey, S. D., Anderson, M. R., Etzioni, R., et al. (2000). Quality of life in survivors of colorectal carcinoma. Cancer, 39, 1294–1303.

    Article  Google Scholar 

  45. Coates, A., Thomson, D., McLeod, G. R., et al. (1993). Prognostic value of quality of life scores in a trial of chemotherapy with or without interferon in patients with metastatic malignant melanoma. European Journal of Cancer, 29A, 1731–1734.

    Article  Google Scholar 

  46. Wisloff, F., Hjorth, M., et al., for the Nordic Myeloma Study Group. (1997). Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma. British Journal of Haematology, 97, 29–37.

    Google Scholar 

  47. Kornblith, A. B., Thaler, H. T., Wong, G., et al. (1995). Quality of life of women with ovarian cancer. Gynecologic oncology, 59, 231–242.

    Article  PubMed  CAS  Google Scholar 

  48. Langendijk, H., Aaronson, N. K., ten Velde, G. P., et al. (1999). Pretreatment quality of life in patients with gIioblastoma multiforme. Oncology Nursing Forum, 26, 921–925.

    Google Scholar 

  49. Yeo, W., Mo, F. K., Koh, J., et al. (2006). Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma. Annals of Oncology, 17, 1083–1089.

    Article  PubMed  CAS  Google Scholar 

  50. Altman, D., & Royston, P. (2000). What do we mean by validating a prognostic model? Statistics in Medicine, 19, 453–473.

    Article  PubMed  CAS  Google Scholar 

  51. Barbare, J. C., Bouché, O., Bonnetain, F., et al. (2005). Treatment of advanced hepatocellular carcinoma with long-acting octreotide: Preliminary results of a randomized placebo-controlled trial (FFCD-ANGH 2001–01 CHOC). Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings, 23(16S), 4036.

  52. Gill, T. M., & Feinstein, A. R. (1994). A critical appraisal of the quality of quality-of-life measurements. The Journal of the American Medical Association, 272, 619–626.

    Article  PubMed  CAS  Google Scholar 

  53. Lipscomb, J., Reeve, B. B., Clauser, S. B., et al. (2007). Patient-reported outcomes assessment in cancer trials: Taking stock, moving forward. Journal of Clinical Oncology, 25, 5133–5140.

    Article  PubMed  Google Scholar 

  54. Simes, R. J., Greatorex, V., & Gebski, V. J. (1998). Practical approaches to minimize problems with missing quality of life data. Statistics in Medicine, 17, 725–737.

    Article  PubMed  CAS  Google Scholar 

  55. Bernhard, J., Cella, D. F., Coates, A. S., et al. (1998). Missing quality of life data in cancer clinical trials : Serious problems and challenges. Statistics in Medicine, 17, 517–532.

    Article  PubMed  CAS  Google Scholar 

  56. Bernhard, J., Sullivan, M., Hurny, C., et al. (2001). Clinical relevance of single item quality of life indicators in cancer clinical trials. British Journal of Cancer, 84, 1156–1165.

    Article  PubMed  CAS  Google Scholar 

  57. Sloan, J. A., Aaronson, N., Cappelleri, J. C., et al., Clinical Significance Consensus Meeting Group. (2002). Assessing the clinical significance of single items relative to summated scores. Mayo Clinic Proceedings, 77, 479–487.

    Google Scholar 

  58. Caumes, J. L., Nousbaum, J. B., Bessaguet, C., et al. (2007). Epidemiology of hepatocellular carcinoma in Finistère. Prospective study from June 2002 to May 2003. Gastroenterologie Clinique et Biologique, 1, 259–264.

    Article  Google Scholar 

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Bonnetain, F., Paoletti, X., Collette, S. et al. Quality of life as a prognostic factor of overall survival in patients with advanced hepatocellular carcinoma: results from two French clinical trials. Qual Life Res 17, 831–843 (2008). https://doi.org/10.1007/s11136-008-9365-y

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