Overall survival and clinically deficient quality of life in patients with esophageal cancer or Barrett's esophagus: A Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry Consortium study.

Abstract

4109 Background: Survival in patients (pts) with cancer has been linked to pt-reported clinically deficient quality of life (cdQOL). We examined patient-reported QOL and overall survival (OS) in pts with esophageal cancer (EC) or Barrett esophagus (BE) previously enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry (EABE). Methods: Pts enrolled in the EABE between 09/01 and 01/09 returned a baseline questionnaire including a validated numerical analogue measure of overall QOL. Pts were categorized as having cdQOL at enrollment as defined by a score of ≤ 5 on a 0-10 scale. Kaplan-Meier methodology and Cox models explored OS in relation to cdQOL in pts with EC and BE. Results: 1,498 pts were included for analysis, 831 had BE (max follow-up of 7.5 years) and 667 had EC (max follow-up of 7.7 years). CdQOL was less likely in BE pts than EC pts (11% vs 28%). Five-year OS rate was significantly less in BE and EC for the cdQOL group (differences of 11% and 24%). Pts, where staging is available, having early stage (T1-2N0M0) EC (158 pts) or locally advanced stage EC (370 pts) had lower 5-year survival rate if they reported cdQOL (27% vs. 73%, HR=0.24, p<0.0001) and (13% vs. 25%, HR=0.58, p<0.0001). None of the pts with metastatic (TxNxM1b) disease (n=62) who had cdQOL survived to 5 years compared to 3% for those with non-cdQOL (p=0.56). Median survival was also significantly less in cdQOL early stage and locally advanced, but not metastatic, EC groups. Conclusions: A deficit in QOL is strongly associated with OS in patients with BE and nonmetastatic EC. CdQOL is a significant predictor of OS in patients with EC and should be considered as a stratification factor in the design of clinical trials. Predictor N (events) 5-year survival rate Cox proportional hazard p value HR (95% CI) BE (N = 831, 77 events) QOL ≤ 5 (cdQOL)QOL > 5 91 (18) 740 (59) 77% (66%–89%)88% (85%–91%) <0.0001 0.30 (0.18–0.51) EC (N = 667, 350 events) QOL ≤ 5 (cdQOL)QOL>5 191 (130)476 (220) 14% (9%–23%)38% (33%–45%) <0.0001 0.46 (0.37–0.58) No significant financial relationships to disclose.