Abstract
Despite the growing use of minimal clinically important difference (MCID) as a cancer outcome measure, no study has reported clinically significant outcomes in cancer patients. We defined MCID and evaluated the use of preoperative HRQoL for predicting MCID and survival after surgical resection of hepatocellular carcinoma (HCC). In total, 369 patients completed the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and the SF-36 at baseline and at two years post-operative at three tertiary academic hospitals. The corresponding MCID values were 3.6 (SF-36 physical component summary), 4.2 (SF-36 mental component summary), 5.4 (FACT-General total score), and 6.7 (FACT-Hep total score). The predictors of achieving postoperative MCID were significantly higher in patients who had low preoperative HRQoL score, advanced age, high education level, and high BMI (p < 0.05). However, patients with a high preoperative HRQoL score, high education level, high BMI, and low Charlson comorbidity index score were significantly associated with survival (p < 0.05). Preoperative HRQoL scores were predictive of MCID and overall survival after surgical resection of HCC. The findings of this study may be useful for managing the preoperative expectations of candidates for HCC resection and for developing shared decision-making procedures for patients undergoing surgical resection of HCC.
Highlights
Hepatic resection is the mainstay curative treatment for patients with hepatocellular carcinoma (HCC), even in some patients with early-stage HCC [1,2,3]
For accurate assessment of postoperative outcome measures, the analysis was limited to patients who had received surgical resection performed by a director of surgery in a medical institution or by a senior attending doctor specializing in HCC surgery or treatment
There was no difference in terms of gender, age, marital status, education, body mass index (BMI), Charlson co-morbidity index (CCI) score, co-residence with family, smoking, drinking, tumor stage, chemotherapy, radiotherapy, average length of stay (ALOS), or in any preoperative Health-related quality of life (HRQoL) parameters mentioned above
Summary
Hepatic resection is the mainstay curative treatment for patients with hepatocellular carcinoma (HCC), even in some patients with early-stage HCC [1,2,3]. Health-related quality of life (HRQoL) is a recognized indicator of healthcare outcomes and, since the 1990s, evaluations of cancer treatment outcomes have increasingly emphasized assessment of HRQoL [4,5]. Disease-specific and generic HRQoL measures are often reported together and provide complementary assessments of patient well-being before and after an intervention. The Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) measure is one of the most widely used patient-reported questionnaires for measuring HRQoL in cancer research [8]. Research has shown that most of the studies that have used the FACT-Hep lack any reporting of clinical significance, even though guidelines for assessing clinical significance do exist
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